r 


REGULATION 

GOVERNING  TOE 

HOSPITALS  JEFS1 

UNITED  Sir-*  •/,•'.•.:.'  HEA13H  i 

192O 


GIFT  OF 


HEALTH 
LIBRARY 


Regulations 

governing  the 

Hospitals  and  Relief  Stations 


of  the 


United  States 
Public  Health  Service 


1920 


Washington 

Government  Printing  Office 
1920 


TREASURY  DEPARTMENT, 

SECRETARY'S  OFFICE, 
Washington,  March  5,  ^0£0. 
•To  officers  of  the  Public  Health  Service,  collectors  of  customs,  and 

others  concerned: 

Upon  the  recommendation  of  the  Surgeon  General  of  the  Public 
Health  Service  and  pursuant  to  acts  of  Congress  of  June  29,  1870, 
July  1,  1902,  August  14,  1912,  March  3,  1919,  and  with  the  approval 
of  the  President  of  January  23,  1920,  the  following  regulations  for 
the  government  of  hospital  and  relief  stations  are  hereby  promul- 
gated for  the  information  and  guidance  of  all  concerned.  All  pre- 
vious regulations  inconsistent  herewith  are  hereby  revoked. 

D.  F.  HOUSTON, 
Secretary  qf  the  Treasury. 
(2) 


CONTENTS. 


Letter  of  promulgation 

Article  I.  General  provisions 

II.  Relief  stations 

III.  District  supervisors " 

Reports 

IV.  Hospital  organization  and  adrainistratlon___ 

Plans  of  administration 

Medical  officer  in  charge 

Executive  officer 

Officer  of  the  day 

Admitting  officer 

Chief  clerk 

Personnel  officer 

Registrar 

Materiel  officer 

Dietetic  service 

Professional  services 

Medical  service 

Tuberculosis  ward 

Neuro-psychiatric  ward 

Isolation  wards 

Surgical  service 

-    Eye,  ear,  nose,  and  throat  department 

Urology 

Ward  surgeons 

Laboratory  service 

Ward  employees 

Nursing  service 

Dental  service 

Reconstruction  service 

V.  Neuro-psychiatric  patients 

VI.  Discipline  of  patients 

VII.  Deceased  patients 

VIII.  Transportation  of  patients 

IX.  Inspection  of  relief  stations 

Inspections  by  medical  officer  in  charge 

X.  Beneficiaries 

Seamen 

The  United  States  Coast  Guard 

Officers  and  employees  of  the  Public  Health  Service 

The  Mississippi  River  Commission 

The  Engineer  Corps,  United  States  Army 

The  Lighthouse  Service 

The  Coast  and  Geodetic  Survey 

Bureau  of  Fisheries 

Injured  civil  employees  of  the  United  States  beneficiaries 

of  the  Federal  employees'  compensation  act 

Patients  of  the  Bureau  of  War  Risk  Insurance 

Patients  for  special  study  and  investigation 

(3) 

427133 


Pago. 
3 


10 

11 


14 
16 
19 

20 
20 


24 

26 


27 
28 
29 
29 
20 
29 
32 
33 
33 
37 
37 
40 


40 
48 


\  59 
59 
60 
60 
60 

61 
70 


Article XI.  Officers  and  enlisted  men  of  the  United  States  Army  and  Navy, 
foreign  seamen,  beneficiaries  of  the  Federal  Board  for  Voca- 
tional Education , 78 

United  States  Army  and  Navy '. 78 

Foreign  seamen 78 

Beneficiaries  of  the  Federal  Board  for  Vocational  Educa- 
tion   79 

XII.  Relief 84 

Out-patient  relief _" 84 

Register  of  out-patients 84 

Fourth-class  stations 80 

In-patient  relief 86 

Register  of  in-patients : 87 

Dental  treatment 89 

XIII.  Public  property 89 

General  provisions 89 

XIV.  Responsibility  for  property  in  hospitals 90 

XV.  Loss  or  destruction  of  property 92 

XVI.  Unserviceable  property 92 

XVII.  Accountability  for  property 94 

Property  returns 95 

Transfer  of  property  between  accountable  officers 96' 

XVIII.  Requisitions  for  property 97 

Stationery  and  blank  forms 98 

XIX.  Special  requisitions  and  purchases 99 

Emergency  purchases 100 

XX.  Medical  and  surgical  supplies __ 102 

Prosthetic  and  orthopedic  apparatus 103 

XXI.  Subsistence,  proposals,  and  contracts 104 

Leases 107 

XXII.  Vouchers 108 

XXIII.  Custodians 110 

APPENDIX. 

Register  of  patients 113 

Supplemental  instructions  for  the  preparation  of  Forms  1971-E  and 

1971-F 113 

Classes  of  beneficiaries 113 

Employees'  compensation  commission 116 

Specimens  of  supplementary  case  reports 116 

Hernia  cases  entitled  to  treatment  under  compensation  act 117 


REGULATIONS  GOVERNING  HOSPITALS  AND  RELIEF  STATIONS 
OF  THE  PUBLIC  HEALTH  SERVICE. 


ARTICLE  I. 
GENERAL  PROVISIONS. 

1.  The  flag  of  the  United  States  shall  be  displayed  at  all  stations 
of  the  first  class  from  sunrise  to  sunset.    On  May  30  the  flag  should 
be  placed  at  half-staff  or  half-mast  until  noon,  when  it  shall  be 
raised  to  the  top  of  the  staff  or  mast.     When  the  flag  is  being  raised 
or  lowered  all  officers  and  employees  who  are  in  the  vicinity  will 
face  toward  the  flag  and  remain  at  attention  until  it  has  reached  tho 
top  or  bottom  of  the  pole,  as  the  case  may  be.    They  will  then  salute. 

2.  Each  station  of  the  first  class  shall  be  entitled  to  two  national 
ensigns,  one  of  the  large  size  (10  feet  hoist)  and  one  a  storm  flag 
(5  feet  hoist).     The  former  shall  be  hoisted  from  a  staff,  erected 
over  or  near  the  executive  building  of  the  hospital,  each  day  from 
sunrise   to  sunset,  except  during  stormy  weather.     Whenever  tho 
weather  is  too  stormy  to  fly  the  large  national  ensign  the  storm  flag 
may  be  set  in  its  place. 

3.  Officers  on  duty  at  first-class  stations  shall  report  before  making 
their  morning  rounds,  to  the  chief  of  the  professional  service  to 
which  they  are  assigned. 

4.  A  junior  officer  shall  not  leave  the  reservation  without  the  con- 
sent of  the  medical  officer  in  charge  or  the  executive  officer. 

5.  An  officer,  before  leaving  the  station,  will  record  his  name,  time 
of  departure  and  destination  in  a  book  which  will  be  kept  at  the 
station  for  the  purpose.    Upon  his  return  to  the  station,  the  time 
will  again  be  recorded. 

6.  The  medical  officer  in  charge,  on  leaving  and  returning  to  the 
reservation,  shall  notify  the  officer  next  in  rank  or  the  executive 
officer. 

7.  Stations  of  the  first  class  shall  not  be  left  without  the  presence 
of  a  medical  officer,  but  if  exception  to  this  rule  is  unavoidable  special 
instructions  shall  be  left  with  the  chief  clerk. 

8.  Stations  of  the  first  class,  when  but  one  medical  officer  and  the 
chief  clerk  are  on  duty,  shall  not  be  left  without  the  presence  of  the 
medical  officer  or  the  chief  clerk. 

9.  Heads  of  wards  and  departments  must  report  to  their  immediate 
superiors  any  dereliction  of  duty  on  the  part  of  employees. 

(5) 


10.  The  station  office  must  not  be  left  during  the  day  without  the 
presence  of  the  chief  clerk  or  other  responsible  employee. 

11.  Employees  will  not  leave  the  station  reservation  without  per- 
mission.    They  will  obtain  such  permission  and  report  their  de- 
parture and  their  return  under  the  general  rules  issued  bv  the  medi- 
cal officer  in  charge.     The  time  of  departure  and  return  will  be 
recorded  in  a  book  kept  for  the  purpose. 

12.  Testimonials  of  character  to  employees  after  leaving  the  service 
are  to  be  given  only  by  the  medical  officer  in  charge. 

13.  The  keys  of  the  station  shall  be  in  the  custody  of  the  officer 
designated  by  the  medical  officer  in  charge.     Keys  must  never  be 
taken  away  from  the  reservation,  and  when  not  in  use  shall  be  kept 
in  a  designated  place. 

14.  Knowledge  of  the  combination  of  the  station   safe   will  be 
guarded  with  the  utmost  care.     Combinations  and  changes  in  combi- 
nations will  be  reported  by  confidential  registered  letter  to  the  Sur- 
geon General — attention  Finance  Section,  Hospital  Division — iden- 
tifying the  safe  by  its  name  and  number. 

15.  Xo  formula  shall  be  introduced  for  ward  use  or  for  use  in  the 
dispensary  without  sanction  of  the  medical  officer  in  charge.     All 
formulae  shall  be  entered  in  the  formula  book  kept  in  the  dispensary 
for  that  purpose. 

16.  The  1st  of  January,  the  22d  of  February,  the  30th  of  May,  the 
4th  of  July,  the  25th  of  December,  and  such  other  days  as  may  be 
so  designated  by  Congress  or  proclaimed  by  the  President  of  the 
United  States,  shall  be  considered  as  holidays  in  the  Public  Health 
Service,  to  be  observed  by  suspension  of  other  than  necessary  labor 
in  the  discretion  of  the  medical  officer  in  charge. 

17.  At  the  discretion  of  the  medical  officer  in  charge  of  stations 
where  State  holidays  are  lawfully  established,  the  same  may  be  ob- 
served by  him  at  his  station  in  the  same  manner  as  a  national 
holiday. 

18.  Sunda}^  shall  be  observed  at  all  stations  of  the  first  class  in  an 
orderly  manner.    All  labor  or  duty  shall  be  reduced  to  the  measure 
oJ  strict  necessity.    The  religious  tendencies  of  officers  and  men  shall 
be  regarded,  and  every  opportunity  consistent  with  the  duties  of  the 
station  afforded  them  to  attend  divine  worship. 

19.  Upon  the  death  of  the  President  or  Vice  President  of  the 
United  States,  the  Secretary  or  Assistant  Secretary  of  the  Treasury, 
or  the  Surgeon  General,  the  medical  officer  in  charge  shall  direct 
that  on  the  day  following,  and  thereafter  until  the  hour  of  the 
funeral,  the  national  ensign  shall  be  set  at  half-staff  or  half-mast. 
The  same  formality  shall  be  observed  at  his  proper  station  whenever 
an  officer  attached  thereto  dies. 


20.  Administrative  assistants  accountable  for  property  or  charged 
with  the  custody  of  the  money  and  valuables  of  patients  shall  furnish 
bond  in  a  reasonable  amount  for  the  proper  handling  of  such  prop- 
erty or  funds  intrusted  to  their  care. 

21.  Officers  and  employees  of  the  Public  Health  Service  detailed 
for  duty  in  connection   with  examination   and   medical   relief   of 
patients  of  the  Public  Health  Service  will,  in  so  far  as  practicable, 
not  be  assigned  additional  duties  in  connection  with  other  functions 
of  the  service. 

22.  Whenever  special  reports  concerning  patients  of  the  Bureau 
of  War  Risk  Insurance  are  sent  by  District  Supervisors,  one  copy  will 
be  referred  to  the  Surgeon  General,  United  States  Public  Health 
Service,  and  a  duplicate  to  the  Chief  Medical  Adviser,  Bureau  of 
War  Risk  Insurance,  notation  of  both  references'  being  made  on 
both  copies. 

23.  All  persons  concerned  Avill  bear  in  mind  the  necessity  of  keep- 
ing the  Chief  Medical  Adviser,  Bureau  of  War  Risk  Insurance,  fully 
informed  regarding  patients  of  the  Bureau  of  War  Risk  Insurance. 

24.  All  persons  concerned  with  the  enforcement  of  the  provisions 
of  the  acts  mentioned  below  will  provide  themselves  with  copies  of 
the  war-risk  insurance  act  and  acts  amendatory  thereto ;  Public  Act 
326  of  the  Sixty -fifth  Congress ;  all  acts  of  Congress  relative  to  the 
Federal  Board  for  Vocational  Education;  and  all  acts  relative  to 
the   Federal    Employees'    Compensation    Commission.      They    will 
thoroughly  familiarize  themselves  with  the  contents  of  these  laws  to 
the  end  that  ignorance  thereof  shall  not  be  held  to  be  sufficient  excuse 
for  failure  properly  to  carry  out  their  provisions. 

25.  All  persons  concerned  with  the  enforcement  of  these  regula- 
tions will  thoroughly  familiarize  themselves  therewith.     In  order 
that  they  may  be  understood  and  intelligently  obeyed,  medical  officers 
in  charge  of  operations  under  these  regulations  will  instruct  the  sta- 
tion personnel  therein. 

26.  The  Surgeon  General  is  hereby  authorized  to  make  such  minor 
corrections  in  these  regulations  as  may  be  necessary  for  the  purpose 
of  correcting  obvious  errors  or  clarifying  points  which  would  other- 
wise be  obscure. 

27.  Officers  charged  Avith   the  enforcement   of  these   regulations 
will  note  in  their  copies  such  changes  as  from  time  to  time  may  be  di- 
rected by  the  Secretary  of  the  Treasury  or  the  Surgeon  General. 

ARTICLE  II. 
BELIEF  STATIONS. 

28.  A  relief  station  is  a  place  where  an  officer  or  other  representa- 
tive of  the  service  is  on  duty  for  the  examination  or  relief  of  patients 
of  the  Public  Health  Service. 


29.  Relief  stations  shall  be  divided  into  the  following  classes: 
CLASS      I.  United  States  Marine  and  Public  Health  Service 

hospitals.    This  class  shall  be  further  divided  into 

the  following  types :  (a)  Capacity  more  than  300 

beds;  (Z>)  capacity  100  to  300  beds;  (c)  capacity 

less  than  100  beds. 
CLASS     II.  All  other  relief  stations  in  charge  of  a  commissioned 

officer. 
CLASS  III.  All  relief  stations  where  an  acting  assistant  surgeon 

is  on  duty  for  the  examination  or  relief  of  patients 

of  the  Public  Health  Service. 
CLASS   IV.  All  other  relief  stations  not  included  in  the  above 

classes. 

30.  The  medical  and  surgical  treatment  of  the  patients  of  the 
Public  Health  Service  will  be  under  the  supervision  of  the  medical 
officers  of  the  service  at  all  relief  stations  where  such  officers  are  on 
duty,  and  they  will  be  required  to  take  direct  professional  charge  of 
the  patients. 

31.  The  outpatient  office  shall  be  located  at  the  customhouse  when- 
ever practicable,  and  suitable  office  space  for  that  purpose  shall  be 
set  apart  by  the  custodian  of  the  customhouse  building  if  space  is 
available,  subject  to  the  approval  of  the  Secretary  of  the  Treasury. 

ARTICLE  III. 
DISTBICT  SUPERVISORS. 

32.  The  United  States  shall  be  divided  into  districts  for  the  pur- 
pose of  furnishing  relief  to  patients  of  the  Public  Health  Service. 

33.  Each  district  will  be  in  charge  of  an  officer  of  the  service, 
who  shall  be  designated  as  the  district  supervisor.     He  shall  have 
supervision  of  the  work  of  providing  relief  to  patients  of  the  Public 
Health  Service  in  his  district.    He  will  furnish  information  to  all 
persons  entitled  to  relief  and  provide  for  their  examination,  hospital 
care,  and  treatment. 

34.  All  service  officers  will  cooperate  with  the  district  supervisors 
in  their  activities,  and  will  furnish  them  with  such  information  and 
aid  as  may  be  practicable. 

35.  Service  officers  who  are  not  under  the  direct  orders  of  dis- 
trict supervisors  will  cooperate  in  every  way  with  the  officer  in  charge 
of  their  district  in  order  that  the  work  may  be  accomplished  in  the 
most  economical  and  advantageous  way. 

36.  Relief  stations  of  the  third  and  fourth  class  shall  be  under  the 
direct  supervision  of  district  supervisors.     All  correspondence,  re- 
ports, proposals,  requisitions,  vouchers,  etc.,  shall  be  forwarded  to  the 


Surgeon  General  through  the  district  supervisor  who  has  charge  of 
the  district  in  which  the  relief  station  is  located. 

37.  Reports  and  vouchers  shall  be  prepared  at  third  and  fourth 
class  stations  and  initialed  by  the  medical  officer  or  deputy  collector 
in  charge,  and  when  received  by  the  district  supervisor  will  be  certi- 
fied by  him  and  forwarded  to  the  Surgeon  General. 

38.  The  District  Supervisor  should  utilize  to  the  utmost  all  facili- 
ties in  Service  hospitals  in  his  district.    Patients  should  not  be  hos- 
pitalized in  contract  hospitals  unless  it  is  impracticable  to  admit  them 
to  Service  hospitals. 

39.  The  amount  to  be  paid  to  hospitals  under  contract  for  the  care 
and  treatment  of  patients  of  the  Public  Health  Service  will  not  ex- 
ceed $3  a  day.    If  a  proposal  received  from  a  hospital  is  more  than 
$3  a  day,  special  authority  must  be  obtained  from  the  Secretary  of  the 
Treasury,  except  in  cases  of  emergency,  when  the  Surgeon  General 
should  be  immediately  notified. 

40.  Whenever  the  words  "  patients  of  the  Public  Health  Service  " 
are  used  in  these  regulations,  they  shall  be  held  to  include  patients  of 
the  Bureau  of  War  Risk  Insurance. 

41.  Hereafter  district  supervisors  and  their  subordinate  personnel 
shall  be  held  to  be  the  field  representatives  of  the  Director  of  the 
Bureau  of  War  Risk  Insurance  and  the  Surgeon  General  of  the 
United  States  Public  Health  Service. 

42.  District  supervisors  will  carry  on  their  operations  under  the 
conjoint  direction  of  the  Chief  of  the  Hospital  Division  and  the  Chief 
Medical  Adviser  for  the  purpose  of  administering  the  functions  listed 
below  connected  with  the  examination  and  relief  of  patients  of  the 
Bureau  of  War  Risk  Insurance,   under  rules  and   regulations  con- 
jointly prescribed  by  the  Director  of  the  Bureau  of  War  Risk  In- 
surance and  the  Surgeon  General  of  the  United  States  Public  Health 
Service,  and  approved  by  the  Secretary  of  the  Treasury. 

(A)  Bureau  of  War  Risk  Insurance. — Determination  of  (a)  Eli- 
gibility to  compensation  and  treatment;  (b)  service  origin,  aggrava- 
tion, nature  and  degree  of  disability  from  injury  or  disease;  (c)  ref-< 
erence  for  treatment;  (d)  payment  of  bills  incident  to  the  discharge 
of  the  above-mentioned  functions. 

(B)  The  United  States  Public  Health  Service  will  furnish  reason- 
able medical,  surgical,  and  hospital  services  and  supplies,  including 
prosthetic  apparatus,  to  such  patients  of  the  Bureau  of  War  Risk  In- 
surance as  may  be  referred  to  it  for  the  same  and  the  payment  of  all 
bills  incident  to  the  discharge  of  these  functions. 

43.  The  Surgeon  General  will  detail  in  each  district  a  district  ex- 
aminer who,  with  his  subordinate  personnel,  will  operate  under  the 
direction  of  the  district  supervisor  for  the  purpose  of  carrying  out 
the  provisions  of  subparagr.aph  (A)  above. 


10 

44.  The  Surgeon  General  will  detail  in  each  district  a  district  relief 
officer  who,  with  his  subordinate  personnel,  will  operate  under  the 
direction  of  the  district  supervisor  for  the  purpose  of  carrying  out 
the  provisions  of  subparagraph  (B)  above. 

45.  All  bills  for  expenditures  incurred  for  examination  of  patients 
of  the  Bureau  of  War  Risk  Insurance  to  determine  their  eligibility 
to  compensation  and  treatment,   including  X-ray  and  laboratory 
bills,  shall  have  the  following  statement  placed  upon  the  face  thereof, 
unless  the  payee  is  under  contract  with  the  Public  Health  Service : 
"  For   examination   to   determine   eligibility  to  compensation   and 
treatment." 

46.  District  supervisors  shall  keep  the  following  record  of  all  ap- 
plicants or  patients  examined  or  treated  in  the  districts  under  their 
charge : 

(1)  Out-patient  record  card,  Form  1971-E. 

(2)  In-patient  record  card,  Form  I971-F. 

(3)  Card  index  of  all  correspondence  with  all  stations  in  the 
district,  from  the  Bureau  of  the  Public  Health  Service,  and  the 
Bureau  of  War  Risk  Insurance. 

47.  Forms  1971-E,  Out-patient  card,  and  1971-F,  In-patient  card, 
shall  each  be  given  a  serial  number  as  soon  as  they  are  filed  in  the 
offices  of  the  district  supervisors.    Serial  numbers  shall  be  consecu- 
tive and  continuous. 


48.  Upon  receipt  of  an  original  or  completed  in-patient  or  out- 
patient report  card,  the  district  supervisor  shall  immediately  execute 
two  copies,  one  of  which  shall  be  forwarded  to  the  Surgeon  General 
and  the  other  to  the  Chief  Medical  Adviser,  Bureau  of  War  Risk  In- 
surance.   Original  cards  011  file  in  offices  of  district  supervisors  may 
be  destroyed  as  soon  as  completed  cards  are  received. 

49.  Upon  receipt  of  completed  Form  1934-B,  Report  of  Physical 
Examination,  district  supervisors  shall  immediately  execute  a  copy 
and  forward  the  same  to  the  Chief  Medical  Adviser,  Bureau  of  War 
Risk  Insurance. 

50.  A  weekly  progress  report  will  be  submitted  by  district  supervi- 
sors to  the  Surgeon  General  at  the  end  of  each  week. 

51.  The  following  monthly  reports  will  be  submitted  by  district 
supervisors  to  the  Surgeon  General :  A  tabulated  report  of  number  of 
cases  examined,  treated,  and  sent  to  hospitals  in  the  district  and  total 
number  for  the  district;  Medical  Officer's  Report  of  Relief,  Form 
1922 ;  Monthly  Schedule  of  Encumbrances,  Form  1955 ;  Vouchers  cov- 
ering expenditures  during  month.  Forms  192C  and  1949 ;  Pay  rolls  for 
all  officers  and  employes  in  the  district ;  Report  of  Pay  Patients,  Form 
1927. 


11 

52.  Special  instructions  will  be  issued  from  time  to  time,  as  re- 
quired, regarding  annual  reports. 

53.  District  supervisors  are  authorized  to  assign  an  officer  to  act 
as  State  supervisor  in  each  of  the  States  comprising  their  districts. 
State  supervisors,  in  their  respective  States,  shall  oversee  the  work 
of  local  examiners  and  act  as  their  advisers  and  instructors  in  all 
matters  pertaining  to  the.  examination  of  claimants.     State  super- 
visors shall  act  as  aides  to  the  district  supervisor,  and  shall  serve 
under  his  orders  only. 

54.  District  supervisors  are  authorized  to  select  strategic  centers 
offering  the  best  hospital  facilities  in  their  districts  for  the  care  and 
treatment  of  patients  of  the  Public  Health  Service.    In  each  of  these 
centers  a  staff  of  attending  specialists  will  be  appointed,  preference 
being  given  to  designated  examiners  who  are  possessed  of  the  requi- 
site qualifications,  for  the  examination  and  treatment  or  for  the  su- 
pervision of  treatment  of  patients  of  the  Public  Health  Service. 
Current  lists  of  these  centers  will  be  furnished  all  examiners  from 
time  to  time. 

55.  Each  of  these  hospitalization  units  will  be  under  the  imme- 
diate supervision  of  an  authorized  representative    of    the    Public 
Health  Service,  appointed  for  full  or  part  time  duty,  at  a  salary 
commensurate  with  the  needs  of  the  service  in  the  localit}'. 

56.  In  cities  where  a  service  hospital  is  located,  the  unit  may  be 
built  around  this  hospital  by  the  medical  officer  in  charge.    In  such 
cases  the  attending  specialists  of  the  service  hospital  should  be  avail- 
able for  the  treatment  of  patients  in  civil  hospitals  in  which  service 
patients  are  being  cared  for,  thus  coordinating  the  work. 

57.  The  acting  assistant  surgeon  or  other  officer  in  charge  of  the 
*  unit  shall  require  the  hospital  furnishing  relief  to  forward  promptly 

to  the  district  supervisor  the  reports  required  by  regulations  upon 
admission  and  discharge  of  patients. 

58.  Patients  will  ordinarily  be  referred  by  examiners  to  the  nearest 
unit.    In  cases  of  emergency,  however,  examiners  are  authorized  to 
proceed  according  to  their  best  judgment,  and  when  the  services 
of  an  attending  specialist  are  not  available  to  obtain  such  services. 
In  all  such  cases  a  report  of  the  action  should  be  sent  to  the  district 
supervisor,  showing  the  necessity  for  the  procedure. 

ARTICLE  IV. 
HOSPITAL  ORGANIZATION  AND  ADMINISTRATION. 

59.  Type  A  and  B  hospitals  are  maintained   for  the   following 
purposes : 

(1)  To  provide  for  the  hospitalization  of  large  numbers  of 
patients. 


12 

(2)  To  afford  better  facilities  than  can  be  provided  at  the 

smaller  hospitals  of  the  service  for  the  treatment  of  se- 
rious, complicated,  obscure,  or  special  cases. 

(3)  To  afford  opportunities  for  the  performance  of  the  more 

complicated   surgical   operations,   facilities   for   which 
may  be  lacking  in  the  smaller  hospitals. 

(4)  To  study,  diagnose,  and  finally  dispose  of  cases  that  have 

long  resisted  treatment  elsewhere. 

(5)  To  instruct  and  train  junior  medical  officers  and  internes 

in  general  professional  and  administrative  duties. 
60.  The  following  tabular  statement  furnishes  a  working  plan  of 
administration  of  hospitals  of  the  service : 

TYPE  A  HOSPITALS. 
MEDICAL  OFFICER  IN  CHARGE. 


EXECUTIVE   OFFICER. 


Professional  division : 

Chief  of  medical  service — 

Medical  wards,  isolation  ward, 
psychiatric  ward,  tuberculo- 
sis ward. 
Chief  of  surgical  service — 

Surgical  wards,  operating 
rooms,  dressing  rooms,  E.  N. 
T.  section,  eye  section,  urol- 
ogy section,  orthopedic  sec- 
tion. 
Chief  of  laboratory  service — 

Chemical   and   bacteriological 
laboratory,    morgue,    X-ray 
laboratory. 
Chief  of  dental  service — 

Dental  clinic,  laboratory. 
Reconstruction  officer — 

Occupational      aids,      physio- 
therapy aids,  Red  Cross. 
.     Chief  nurse. 

Nursing  service. 
Admitting  officer- 
Admission    and    discharge    of 
patients,  observation  room. 


Administrative  division: 
Chief  clerk- 
Correspondence,   records,   and 

files. 
Personnel  officer — 

Male  employees. 
Registrar — 

Completed     clinical     records, 
war  risk  insurance  records  . 
and    reports ;    inquiries    re- 
garding  patients,    patients' 
effects,  post  office,   register 
of  patients. 
Materiel  officer — 

Transportation,  property,  dis- 
pensary,    shops,     buildings 
and  grounds,  laundry. 
Chief  dietitian- 
Kitchens,   dining  rooms,   sub- 
sistence storerooms. 


OFFICER  OF   THE  DAT, 


13 

TYPE  B  HOSPITALS. 
MEDICAL  OFFICES  IN  CHARGE. 

EXECUTIVE    OFFICEB. 


Professional  division : 
Clinical  director — 

Medical  wards,  isolation  ward, 
surgical  wards,  tuberculosis 
ward,  genito-urinary  ward, 
operating  room,  dressing 
rooms,  chemical  and  bac- 
teriological laboratory,  X- 
ray  laboratory,  morgue, 
dental  section,  out-patients' 
section. 
Reconstruction  officer — 

Occupational      aids,      physio- 
therapy aids,  Red  Cross. 
Chief  nurse. 

Nursing  service. 
Officer  of  the  day — 

Admission    and    discharge    of 
patients,   observation   room. 


Administrative  division : 
Chief  clerk- 
Correspondence,  records,   and 
files;  male  employees,  com- 
pleted clinical  records,  war 
risk  insurance  records  and 
reports,  inquiries  regarding 
patients,     patients'     effects, 
post  office,   register  of  pa- 
tients. 

Materiel  officer- 
Transportation,  property,  dis- 
pensary,    shops,     buildings 
and  grounds,  laundry. 
Chief  dietitian- 
Kitchens,   dining   rooms,   sub- 
sistence storerooms. 


OFFICER   OF   THE    DAY. 

TYPE  C  HOSPITALS. 
MEDICAL  OFFICER  IN  CHARGE. 


Professional  division: 
Medical  officers. 
Nurses. 


Administrative  division: 
Chief  clerk. 
Dietitian. 


OFFICER  OF  THE  DAY. 


MEDICAL  OFFICER  IN  CHARGE. 

61.  The  medical  officer  in  charge  is  in  charge  of  the  hospital,  its 
personnel  and  patients,  and  shall  administer  all  the  affairs  thereof. 

62.  He  shall  be  responsible  for  the  preservation  and  proper  appli- 
cation of  public  property,  and  for  the  proper  condition  of  buildings 
and  grounds.    In  type  A  and  type  B  hospitals  he  shall  leave  the  de- 
tails of  administration  to  subordinate  officers  as  far  as  practicable. 
He  shall  make  such  reports  to  the  Surgeon  General  as  are  required  by 
regulations.    He  shall  require  a  proper  performance  of  duty  by  the 
entire  personnel  of  the  station  and  observance  of  rules  by  all  patients. 
He  shall  make  and  enforce  proper  regulations  for  the  sanitary,  dis- 
ciplinary, and  other  internal  requirements  of  the  hospital. 


14 

63.  In  type  A  and  type  B  hospitals  he  shall  make  a  detailed  inspec- 
tion of  the  wards  and  departments  every  Saturday.    In  addition,  in- 
formal, unannounced  inspections  of  separate  wards  or  departments 
should  be  made  daily. 

64.  In  type  C  hospitals  he  shall  visit  the  hospital  wards  once  eacli 
day,  and  oftener,  if  necessary.    The  morning  sick  call  shall  be  made 
not  later  than  9  o'clock  each  day,  and  the  medicines  ordered  shall 
be  compounded  and  delivered  to  the  nurses  as  soon  as  practicable 
after  the  termination  of  the  visit.     The  evening  sick  call  shall  be 
made  at  a  time  fixed  by  the  medical  officer  in  charge  between  5.30 
and  6.30  p.  m.  daily  by  an  officer  of  the  staff  detailed  by  the  medical 
officer  in  charge,  and  he  shall  be  accompanied  by  the  night  nurse  and 
by  the  day  nurse  in  each  ward. 

EXECUTIVE  OFFICER. 

65.  In  type  A  and  type  B  hospitals  a  medical  officer  will  be  assigned 
as  "executive  officer"  of  the  hospital.  Under  the  direction  of  the 
medical  officer  in  charge  he  shall  have  charge  of  the  correspondence, 
reports,  and  various  rosters  of  the  service.    He  shall  prepare,  verify, 
and  issue  all  orders,  instructions,  and  details ;  keep  the  records  of  the 
hospital,  and  perform  such  other  duties  as  are  required  by  regula- 
tions.   He  is  the  representative  of  the  medical  officer  in  charge,  and 
through  him  the  medical  officer  in  charge  communicates  with  the  per- 
sonnel and  patients  in  the  hospital. 

66.  He  shall  keep  accurate  rosters  of  all  officers,  nurses,  and  other 
employees,  assigned  by  the  medical  officer  in  charge  to  the  perform- 
ance of  their  various  duties,  and  promptly  notify  them  of  their  as- 
signment. 

67.  The  executive  officer  should  be  courteous  to  and  on  friendly 
terms  with  the  officers  of  the  station,  and  should  avoid  all  discussion  of 
the  orders  or  the  acts  of  his  superiors.    He  shall  endeavor  at  all  times 
to  exert  influence  belonging  to  his  position,  and  on  proper  occasion, 
aid  with  his  advice  the  junior  officers  of  the  hospital. 

OFFICES  OF  THE  DAT. 

68.  The  medical  officer  in  charge  shall  detail  each  of  the  junior 
medical  officers  in  rotation  to  act  as  officer  of  the  day.    The  detail 
shall  be  posted  daily  on  the  day  preceding  that  on  which  the  officer 
of  the  day  is  to  serve. 

69.  His  tour  of  duty  shall  be  24  hours,  and  will  commence  at  an 
hour  to  be  designated  by  the  medical  officer  in  charge,  at  which  time 
he  shall  meet  the  old  officer  of  the  day  in  the  office  of  the  medical 
officer  in  charge  to  receive  such  instructions  as  the  medical  officer 


15 

in  charge  may  desire  to  give.     Chiefs  of  service,  pathologists,  and 
officers  serving  in  contagious  wards  shall  not  be  assigned  to  this  duty. 

70.  The  officer  of  the  day  shall  not  leave  the  limits  of  the  hospital 
during  his  tour  of  duty  without  the  express  authority  of  the  medical 
officer  in  charge,  and  only  after  a  proper  substitute  has  been  de- 
tailed. 

71.  He  shall  make  at  least  three  rounds  of  inspection  of  the  hos- 
pital wards  and  grounds  during  his  tour  of  duty.     On  the  morning 
tour  of  inspection  he  shall  visit  all  wards  and  make  inquiries  of 
ward  surgeons  concerning  seriously  sick  patients  who  may  need 
attention  during  the  night.    The  hospital  grounds  and  messes  will 
also  be  inspected  on  this  tour. 

72.  On  the  evening  tour  of  inspection  he  shall  see  that  the  watch- 
men are  at  their  posts,  that  the  nurses  and  attendants  are  in  their 
wards,  and  that  they  are  properly  performing  their  duties.     On  the 
night  tour  his  inspection  shall  be  made  similar  to  the  second,  noting 
especially  if  the  watchman  and  night  attendants  are  at  their  posts 
and  performing  their  prescribed  duties,  and  when  practicable,  imme- 
diately correcting  any  disorder  or  neglect. 

73.  In  all  inspections  it  is  his  duty  personally  to  ascertain  that 
patients  are  receiving  proper  attention  and  to  give  such  emergency 
treatment  as  may  be  demanded,  recording  the  same  on  the  patient's 
clinical  record. 

74.  In  the  winter  he  shall  see  that  the  wards  are  properly  heated 
and  ventilated  and  that  care  has  been  taken  to  shut  off  the  water 
supply,  if  necessary,  to  prevent  freezing.    He  shall  give  instructions 
to  ward  employees  to  be  careful  and  vigilant  with  regard  to  fires.    In 
the  event  of  an  outbreak  of  fire  he  shall  immediately  assume  charge 
juntil  the  arrival  of  the  fire  marshal,  taking  measures  in  the  meantime 
to  sound  the  alarm  and  extinguish  the  fire,  if  possible. 

75.  In  case  of  serious  illness  or  death  of  patients  during  the  night, 
he  is  authorized  to  send  a  brief  official  message  notifying  the  rela- 
tives of  the  fact.    In  such  event  he  should  use  care  and  discretion, 
as  often,  owing  to  the  lateness  of  the  hour,  telegrams  can  not  be  for- 
warded until  morning,  when  such  message  could  be  sent  more  ex- 
pediently by  the  officer  in  charge  of  the  reports  of  patients. 

76.  In  case  of  death  the  officer  of  the  day  shall  immediately  exam- 
ine the  body  personally,  superintend  its  removal  to  the  morgue,  mak- 
ing a  record  of  the  name  of  the  deceased  and  the  address  of  the 
nearest  relative.    He  shall  remove  Form  1971-H  from  the  foot  of  the 
patient's  bed  and  attach  it  to  the  body  of  the  deceased.    On  this  form 
must  be  entered  the  patient's  name,  register  number,  permanent  ad- 
dress, name  and  address  of  nearest  relative,  and  the  ward  in  which 
the  patient  died.    This  tag  must  invariably  be  attached  to  the  body 


16 

of  the  deceased  and  not  to  the  clothing,  and  must  not  be  removed 
until  the  body  has  been  prepared  for  burial  or  shipment.  He  shall 
collect  all  money,  valuables,  and  other  effects  in  the  possession  of  the 
patient  at  time  of  death  and  deliver  them  to  the  officer  charged  with 
the  custody  of  the  same.  In  all  such  cases  he  shall  submit  a  written 
report  of  the  death,  with  all  necessary  data,  to  the  officer  in  charge 
of  the  records  of  patients,  and  also  include  the  same  in  his  written 
report  to  the  medical  officer  in  charge  at  the  close  of  his  tour  of  duty. 

77.  In  large  hospitals  of  the  service,  where  a  regular  admitting 
officer  is  detailed  by  the  medical  officer  in  charge,  the  officer  of  the 
day  shall  relieve  him  at  all  times  when  the  admitting  officer  is  not 
on  duty.    At  hospitals  in  which  no  regular  admitting  officer  is  de- 
tailed, the  officer  of  the  day  will  act  as  admitting  officer. 

78.  Should  the  officer  of  the  day  be  in  doubt  concerning  the  nature 
of  the  illness  of  an  incoming  patient  he  should  request  the  executive 
officer  to  arrange  for  a  consultation.    In  all  cases  where  consultation 
is  not  immediately  available  the  patient  shall  be  placed  in  the  obser- 
vation ward  at  the  admitting  station  for  further  examination. 

79.  When  the  duties  of  the  officer  of  the  day  require  him  to  be  away 
from  the  admitting  station,  he  shall  leave  definite  instructions  with 
the  employee  in  charge  in  order  that  he  may  be  found  quickly  at  all 
times.    He  should  sleep  in  a  room  provided  for  the  purpose  in  close 
proximity  to  the  admitting  station.    He  shall  at  all  times,  during  the 
night,  be  available  for  emergency  sick  calls  from  the  wards. 

80.  The  duties  of  the  officer  of  the  day  are  of  wide  range  and 
most  important  in  character.    In  the  absence  of  the  medical  officer 
in  charge  and  the  executive  officer,  he  is  in  charge  of  the  hospital 
under  the  senior  officer  present.     It  is  his  duty  to  give  such  orders 
and  make  such  recommendations  as  may  be  to  the  best  interests  of 
the  hospital  for  the  time  being,  and  to  see  that  no  patient  is  neglected, 
and  that  no  irregularities  occur  which  may  bring  discredit  upon  the 
station  and  upon  the  service. 

81.  At  the  expiration  of  his  tour  of  duty  he  shall  make  a  report 
in  writing  in  the  book  provided  for  the  purpose  in  the  office  of  the 
medical  officer  in  charge,  noting  the  hours  at  which  his  inspections 
were  made,  and  reporting  neglects,  disorders,  deaths,  or  infractions 
of  hospital  rules  that  may  have  occurred  during  his  tour,  and  any 
other  matters  which  may  properly  be  brought  to  the  attention  of  the 
medical  officer  in  charge. 

ADMITTING  OFFICER. 

82.  The  admitting  officer  shall  make  a  complete  examination  with- 
out delay  of  all  patients  applying  for  treatment  in  the  hospital  and 
assign  them  to  the  proper  wards  or  departments  for  treatment.    Pa- 


37 

tients  requiring  out-patient  treatment  only  will  be  directed  by  the 
admitting  officer  to  the  proper  place  for  treatment. 

83.  The  admitting  officer  will  prepare  and  sign,  in  duplicate,  the 
upper  portion  of  the  first  page  of  the  clinical  record  at  the  time  of 
admission  of  each  in-patient.    The  original  will  be  sent  to  the  ward 
with  the  patient  and  the  duplicate  to  the  registrar,  or  to  the  chief 
clerk  in  hospitals  where  no  registrar  is  assigned.    The  registrar  will 
use  this  report  for  the  purpose  of  preparing  original  report  card 
form  1971-F.    If  any  unusual  circumstances  are  connected  with  the 
admission  of  the  patient,  notation  will  be  made  of  the  same  on  the 
first  page  of  the  clinical  record  at  the  time  of  admission. 

84.  Each  patient  will  be  questioned  by  the  admitting  officer  with 
respect  to  money  or  valuables  in  his  possession.    All  money  and  valu- 
ables received  from  patients  at  the  time  of  admission  must  be  immedi- 
ately delivered  by  the  admitting  officer  to  the  officer  charged  with  the 
custody  of  the  same.    If  the  patient  has  no  money  or  valuables  in  his 
possession,  he  will  be  required  to  sign  a  statement  to  that  effect  on 
Patient  Property  Card,  Form  1971-J.     In  cases  of  emergency  the 
admitting  officer,  after  administering  treatment  immediately  neces- 
sary, may  send  patients  directly  to  their  proper  wards,  delegating  to 
the  ward  surgeon  the  responsibility  for  completing  records  of  admis- 
sion and  receiving  money  and  valuables. 

85.  The  admitting  officer  shall  closely  examine  all  cases  for  com- 
municable disease.    Such  cases  shall  be  sent  immediately  to  the  iso- 
lation ward.    Suspects  shall  be  detained  in  the  observation  ward  at 
the  admitting  station  until  the  diagnosis  has  been  verified  by  consul- 
tation.   Psychotic  patients  shall  be  sent  immediately  to  the  officer  in 
charge  of  the  psychiatric  ward. 

86.  If  a  patient  is  admitted  to  a  hospital  as  the  result  of  a  disease 
•or  injury  in  which  there  is  a  question  as  to  his  being  entitled  to  treat- 
ment, the  medical  officer  in  charge  should  be  consulted,  all  facts 
connected  with  the  case,  ascertained,  and  the  question  settled  at  the 
earliest  possible  date.    Pending  definite  decision,  care  and  treatment 
must  be  furnished  to  patients  in  every  case. 

87.  The  admitting  officer  shall  be  responsible  for  the  proper  care 
and  treatment  of  patients  from  the  time  of  their  admission  until  the 
proper  ward  surgeon  has  assumed  charge.    Patients  shall  always  be 
conducted  to  the  wards  by  the  necessary  attendants. 

88.  In  hospitals  requiring  the  same,  on  account  of  the  large  num- 
ber of  patients,  a  cross  index  file  of  locator  cards  shall  be  kept  in  the 
office  of  the  admitting  officer.    Two  cards  shall  be  prepared  for  each 
in-patient.    On  both  copies  shall  be  recorded : 

(1)  Name  of  the  patient;  (2)  register  number;  (3)  permanent  ad- 
dress; (4)  ward  to  which  assigned. 
185279°— 20 2 


18 

89.  Locator  cards  shall  be  kept  in  two  files :  In  file  1,  the  cards  shall 
be  filed  alphabetically  according  to  the  surnames  of  the  patients;  in 
file  2,  the  cards  shall  be  filed  according  to  wards. 

90.  When  ward  transfers  are  about  to  be  made,  the  authorization 
will  be  sent  to  the  admitting  officer  for  his  counter  signature  in  order 
that  locator  cards  in  both  files  may  be  changed  to  correspond  with 
the  new  location  of  the  patients. 

91.  The  purpose  of  file  1  is  to  enable  the  admitting  officer  and  the 
information  clerk  to  determine  immediately  the  location  of  a  patient 
in  the  hospital.    The  purpose  of  file  2  is  to  furnish  to  the  admitting 
officer  an  accurate  record  of  the  number  of  occupied  and  available 
beds  in  each  ward. 

92.  When  a  patient  is  discharged  his  locator  cards  may  be  removed 
from  both  files  and  destroyed. 

93.  Patients  being  discharged  or  transferred  shall  be  inspected  by 
the  admitting  officer,  who  shall  see  that  they  are  properly  dressed  and 
have  all  property  and  valuables  belonging  to  them  before  their  de- 
parture.   He  shall  also  note  the  physical  condition  of  all  patients  at 
the  time  of  discharge,  and  if  there  is  any  who  in  his  opinion  is 
not  able  to  travel,  make  report  of  the  same  to  the  chief  of  service 
concerned. 

94.  The  admitting  officer  must  be  notified  in  advance  by  chiefs  of 
service  of  the  intended  discharge  or  transfer  of  all  patients. 

95.  The  registrar  must  be  notified  by  the  admitting  officer  before 
discharge  of  every  patient,  in  order  that  all  hospital  records  may  be 
complete  and  that  the  patient  may  have  the  records,  clothing,  and 
valuables  to  which  he  is  entitled  upon  his  departure. 

96.  When  patients  arrive  at  the  hospital  the  employee  in  charge  of 
the  admitting  station  shall  immediately  call  the  admitting  officer  and 
arrange  for  the  comfort  of  the  patient  pending  the  officer's  arrival. 
He  shall  personally  see  that  accurate  records  of  admission  are  made. 

97.  A  suitable  room  in  the  admitting  station  shall  be  used  for 
the   observation   and   temporary   detention   of    suspected    cases    of 
communicable  disease.     The  admitting  officer  shall  be  in  charge  of 
this  ward* and  one  employee  will  be  detailed,  when  necessary,  as 
attendant. 

98.  Persons  desiring  to  visit  patients  in  hospitals  shall  be  admitted 
onlv  through  the  admitting  office,  after  the  location  of  the  patient  has 
been  determined  by  consulting  the  locator  file.     If  the  condition  of 
the  patient  is  such  that  the  visit  will  not  interfere  with  his  care  and 
treatment,  a  pass  signed  by  the  admitting -officer  will  be  given  to  the 
visitor,  permitting  him  to  enter  the  public  reception  room  or  the 
ward  where  the  patient  is  being  treated  if  the  patient  is  unable  to 
come  to  the  reception  room. 


19 

99.  Visitors  will  not  be  allowed  at  other  than  regular  visiting  hours 
011  Tuesdays,  Thursdays,  and  Sundays.    Xo  passes  will  be  given  that 
will  permit  visitors  to  enter  contagious  disease  wards,  except  that 
adults  over  16  years  of  age  may  be  given  permission  to  visit  tuber- 
culosis wards.     No  patient  will  be  permitted  to  receive  more  than 
four  visitors  at  a  time  in  the  ward  where  he  is  receiving  treatment. 

100.  Women  visitors  will  not  be  permitted  to  enter  venereal-disease 
wards. 

101.  In  exceptional  cases  regulations  regarding  visitors  may  be 
modified  as  the  necessity  demands.    The  admitting  officer  shall  satisfy 
himself  with  regard  to  the  character  of  all  visitors,  and  exclude  all 
undesirables.    Visitors  having  acute  colds  or  other  communicable  dis- 
ease will  be  denied  admittance. 

102.  Persons  desiring  to  enter  the  hospital  wards  for  purposes 
other  than  that  of  visiting  patients  shall  be  referred  to  the  medical 
officer  in  charge  or  to  the  executive  officer. 

103.  When  a  junior  officer  wishes  to  conduct  visitors  through  the 
hospital,  or  to  extend  an  invitation  to  any  hospital  event,  the  con- 
sent of  the  medical  officer  in  charge  shall  first  be  obtained. 

104.  Ambulance  drivers,  except  in  cases  of  emergency,  will  report 
at  the  admitting  office  before  departing  on  a  call.     A  card  will  be 
given  to  the  driver,  on  which  will  be  recorded  his  name,  the  name 
of  the  patient,  the  time  of  departure,  and  the  destination.     Verbal 
instructions  must  never  be  allowed  to  serve  in  lieu  of  written  instruc- 
tions except  in  cases  of  grave  emergency  where  haste  is  necessary. 

105.  The  ambulance  driver  Avill  record  on  the  card  the  time  of 
arrival  at  destination.     He  .will  also  record  any  unusual  circum- 
stances connected  with  the  call,  such  as  failure  to  locate  the  patient, 
or  delays  which  may  have  occurred.    Upon  the  return  of  the  ambu- 

"  lance  the  time  will  be  recorded,  and  the  completed  card  will  be  filed 
in  the  office  of  the  admitting  officer. 

CHIEF    CLERK. 

106.  At  all  hospitals  an  administrative  assistant  or  pharmacist  will 
be  assigned  as  chief  clerk.    The  chief  clerk  shall  be  in  charge  of  the 
preparation  and  filing  of  correspondence,  reports,  orders,  and  the 
various  rosters  of  the  personnel. 

107.  The  chief  clerk  shall  be  charged  with  all  the  duties  and  re- 
sponsibilities of  the  registrar,  the  personnel  officer,  and  the  materiel 
officer  in  hospitals  at  which' no  registrar,  personnel  officer,  or  ma- 
teriel officer  is  assigned. 


20 

PERSONNEL   OFFICER. 


108.  In  type  "A"  hospitals,  when  especially  authorized  by  the 
Surgeon  General,  an  administrative  assistant  or  pharmacist  shall 
be  assigned  as  personnel  officer.  He  shall  have  immediate  charge 
of  the  assignment  of  all  male  employees  in  the  hospital,  supplying 
such  details  temporarily  or  permanently  to  the  several  wards  or 
departments  as  may  be  directed  by  the  medical  officer  in  charge. 
He  shall  be  responsible  for  the  discipline,  instruction,  quartering, 
and  proper  keeping  of  accounts  and  records  of  all  such  employees. 


REGISTRAR. 


109.  In  type  "A"  hospitals  a  pharmacist  or  administrative  assist- 
ant will  be  assigned  as  registrar.    He  shall  have  charge  of  the  com- 
pleted clinical  records,  the  register  of  patients,  all  other  medical  and 
surgical  records,  and  all  reports  pertaining  to  patients  of  the  Bureau 
of  War  Risk  Insurance  and  other  classes  of  patients  in  the  hospital. 
He  shall  be  charged  with  the  custody  of  the  money,  valuables,  and 
other  effects  of  patients.    All  inquiries  concerning  patients  shall  be 
referred  to  his  department. 

110.  Whenever  the  condition  of  a  patient  becomes  critical  he  shall 
notify  by  official  telegram  the  nearest  relative  or  friend,  and  there- 
after, if  requested,  daily  reports  may  'be  sent  by  telegram  at  the 
expense  of  the  person  who  requested  the  same.    Upon  the  death  of  a 
patient  he  shall  notify,  by  official  telegram,  the  nearest 'relative  or 
friend  of  the  deceased. 

111.  Upon  the  admission  of  each  patient  a  search  will  be  made  in 
the  index  to  register  of  inpatients  for  records  of  former  admission. 
In  the  event  of  previous  admission  the  clinical  record  in  the  case 
shall  be  sent  to  the  ward  surgeon  for  his  information,  who  will  enter 
a  brief  of  previous  admission  on  the  current  history  of  the  case,  and 
return  the  original  clinical  record  to  the  registrar's  office.    The  regis- 
trar shall  keep  a  check  of  such  records  to  insure  their  safe  return. 

112.  When  a  patient  undergoing  treatment  in  the  hospital  is  absent 
without  leave,  the  registrar  shall  immediately  notify  the  medical 
officer  in  charge.    In  the  event  that  a  patient  has  been  absent  and 
returns  to  the  hospital  a  like  report  shall  be  made. 

113.  When  information  is  requested  by  any  person  regarding  the 
disease  for  which  any  patient  of  the  service  has  been  under  treat- 
ment, the  registrar  shall  furnish  such  information  only  by  direction 
of  the  medical  officer  in  charge.  _. 

114.  No  clinical  record  or  copy  of  the  same  shall  be  withdrawn 
from  the  files  of  the  hospital  or  furnished  to  any  person  except  upon 
the  written  order  of  the  Surgeon  General. 


21 

115  The  registrar  shall  place  the  money  and  valuables  of  each 
patient  in  envelope,  Form  1970,  which  shall  be  sealed  and  deposited 
in  the  hospital  safe.  He  shall  keep  an  accurate  record  of  all  such 
transactions,  and  shall  receipt  for  the  articles  on  Patient's  Property 
Card,  Form  1971-J,  upon  the  admission  of  each  patient,  and  obtain 
like  receipt  for  all  articles  delivered  to  the  patient  or  to  his  legal 
representative  on  discharge  from  the  hospital. 

116.  The  registrar  shall  have  charge  of  the  storeroom  for  patients' 
effects.    The  employee  on  duty  in  the  patient's  property  room  under 
the  direction  of  the  registrar  shall  be  responsible,  for  the  safe-keeping 
and  care  of  all  property  in  the  storeroom,  and  the  preparation  of 
all  records  pertaining  thereto. 

117.  The  articles  shall  be  enumerated  on  Form  1971-J,  Patient's 
Property  Card,  which  shall  be  prepared  in  duplicate.    The  original 
shall  be  placed  on  file  and  the  duplicate  given  to  the  patient.    Pa- 
tient's Property  Card,  Form  1971-J,  will  be  kept  in  three  files:  (1) 
The  current  file,  consisting  of  cards  of  patients  who  are  being  treated 
in  the  hospital;   (2)  the  permanent  file,  consisting  of  cards  of  pa- 
tients who  have  been  discharged  from  the  hospital  and  whose  effects 
have  been  returned;  (3)  the  suspended  file,  consisting  of  cards  for 
deceased  patients  and  patients  who  have  left  the  hospital  without 
their  effects. 

118.  Efforts  should  be  made  to  dispose  promptly  of  the  effects  of 
deceased  patients  and  effects  left  in  the  storeroom  by  patients  who 
have  left  the  hospital.     When  proper  disposition  has  been  made, 
cards  in  the  suspended  file  will  be  transferred  to  the  permanent  file. 

119.  Except  in  emergency,  all  effects  of  patients  not  needed  in  the 
hospital  will  be  delivered  to  the  registrar  at  the  time  of  admission. 
One  or  more  separate  compartments  shall  be  used  for  each  patient's 
effects.    Patient's  Claim  Check,  Form  1971-1,  will  be  attached  to  all 
effects  before  storing  in  the  compartments.     The  outer  half  of  the 
check  will  be  removed  and  given  to  the  patient.    Each  check  will  be 
numbered  to  correspond  with  the  number  of  the  compartment  in 
which  the  property  is  stored.    The  check  numbers  for  each  patient 
wyill  be  entered  upon  the  patient's  property  card. 

120.  In  cases  of  emergency  where  valuable  effects  go  to  a  ward 
at  time  of  admission  with  a  patient  who  is  unable  to  care  for  his 
effects,  the  ward  surgeon  shall  be  responsible  for  the  same  until  they 
are  delivered  to  the  storeroom  authorities. 

121.  Clothing  and  baggage  will  be  removed  from  the  storeroom 
only  by  order  of  the  registrar,  and  the  person  removing  such  bag- 
gage must  sign  a  receipt  therefor  on  the  patient's  property  card. 

122.  During  the  temporary  absence  of  the  registrar  from  the  hos- 
pital, the  admitting  officer  will  receive  the  money  and  valuables  of 


22 

any  incoming  patients  and  sign  for  the  same  on  patient's  property 
cards.  In  such  cases  the  admitting  officer  will  immediately  deliver 
the  funds  to  the  medical  officer  in  charge  for  deposit  in  the  hospital 
safe.  Upon  the  return  of  the  registrar  to  the  hospital  the  transac- 
tion will  be  verified  and  the  registrar  will  assume  the  custody  of 
the  funds  and  sign  for  the  same  on  patient's  property  cards. 

123.  The  officer  of  the  day  will  assume  the  custody  of  the  money 
and  valuables  of  incoming  patients  at  all  times  when  the  registrar 
and  admitting  officer  are  not  on  duty.    In  such  event  the  officer  of 
the  day  will  deliver  the  funds  to  the  registrar  the  next  morning. 

124.  If  the  registrar  departs  from  the  station  on  leave  of  absence 
for  a   period  exceeding  one  week,  he  will  regularly  transfer  the 
money,  valuables,  and  other  effects  of  patients  intrusted  to  his  care 
to  another  custodian,  detailed  for  the  purpose  by  the  medical  offi- 
cer in  charge.    In  making  such  transfer  an  invoice  will  be  prepared 
from  the  patient's  property  cards  in  the  current,  file  and  checked 
against  the  funds  and  effects  deposited  in  the  safe  and  storeroom. 
The  invoice  will  be  signed  by  the  registrar,  and  the  new  custodian 
will  receipt  for  the  funds  and  effects  under  the  signature  of  his 
predecessor. 

125.  Unless  a  United  States  postal  station  has  been  established 
upon  the  reservation,  the  registrar  shall  have  charge  of  the  receipt 
and  delivery  of  all  mail  to  the  patients  and  personnel  of  the  hospital. 

126.  One  employee  of  known  probity  and  good  habits  will  be  de- 
tailed in  charge  of  the  hospital  post  office,  under  the  supervision  of 
the  registrar,  and  will  be  assisted  by  the  necessary  numjjer  of  other 
employees.    He  will  be  held  responsible  for  the  prompt  and  safe  de- 
livery of  all  mail  to  the  proper  persons. 

127.  All  registered,  insured,  and  special  delivery  mail  must  be  de- 
livered by  an  employee  of  the  post  office  direct  to  the  addressee.    He 
will  be  required  to  obtain  proper  receipts  for  the  same.     A  record 
of  all  registered,  special  delivery,  and  insured  articles  shall  be  kept 
in  a  book  provided  for  the  purpose  at  the  post  office,  showing  the 
receipt  and  delivery  of  all  mail  «f  this  class. 

128.  A  book  containing  the  forwarding  address  of  all  patients  who 
have  left  the  hospital  will  be  kept  in  the  hospital  post  office. 

MATERIEL  OFFICER. 

129.  In  type  "A"  and  type  "B"  hospitals,  an  administrative  as- 
sistant or  pharmacist  will  be  assigned  as  materiel  officer. 

130.  The  materiel  officer  will  be  charged  with  the  following  duties : 
Periodical  accountability  for  all  property;  requisition  for  property; 
issue  of  property  to  responsible  officers;  responsibility  for  all  prop- 
erty in  his  custody;  making  of  authorized  purchases  of  property; 


23 

transportation ;  repair  and  upkeep  of  buildings;  repair,  upkeep,  and 
operation  of  mechanical  equipment;  upkeep  and  care  of  grounds; 
disposal  of  waste;  issue  of  all  prescriptions  from  the  dispensary  to 
wards  and  out-patient  offices;  laundering  of  all  washable  materials. 

131.  The  materiel  officer  will  be  in  charge  of  the  garage,  stables, 
shops,  and  hospital  gardens. 

132.  He  will  be  responsible  for  the  care  and  upkeep  of  all  vehicles 
and  for  their  neat  and  cleanly  appearance.     He  will  instruct  all 
chauffeurs  with  regard  to  the  observance  of  speed  limits,  and  other 
rules  of  the  road.    He  will  keep  an  accurate  account  of  oil  and  gaso- 
line consumed  by  motor  vehicles.    He  will  exercise  strict  supervision 
over  their  use  in  order  that  they  may  be  used  for  authorized  pur- 
poses only.    He  will  not  permit  a  motor  vehicle  to  be  taken  apart  or 
otherwise  tampered  with  except  by  a  competent  mechanic. 

133.  The  care  of   the   hospital  grounds,   the   cleanliness   of   the 
various  shops  and  warehouses,  all  grass,  together  with  the  collection 
and  disposition  of  all  waste,  will  be  in  charge  of  the  material  officer. 
All   territory   within   the   hospital   reservation   will  be  thoroughly 
cleaned  each  morning  and  maintained  in  this  condition  throughout 
the  day. 

134.  A  qualified  druggist  will  be  in  charge  of  the  dispensary, 
under  the  direction  of  the  materiel  officer,  and  will  be  responsible  for 
its  ]) roper  operation. 

135.  All  prescriptions  will  be  written  on  form  1921-A  and  will  be 
signed  by  a  medical  officer,  except  w  extreme  emergencies.     Should 
such  emergency  arise,  a  written  order,  signed  by  a  medical  officer, 
will  be  obtained  later. 

136.  The  materiel  officer  will  satisfy  himself  that  regulations  with 
regard  to  care  of  alcohol  and  narcotic  drugs  are  observed.    Prescrip- 
tions for  alcohol  or  alcoholic  beverages  and  habit-forming  drugs  must 
be  signed  in  ink. 

137.  All  prescriptions  compounded  will  be  placed  in  two  separate 
files,  as  follows:   (1)   Prescriptions  for  alcohol  or  alcoholic  bever- 
ages and  for  medicines  containing  opium  or  any  of  the  salts,  deriva- 
tives, or  preparations  of  opium  or  coca  leaves;   (2)   all  other  pre- 
scriptions. 

138.  Prescriptions  will  be  numbered  serially  in  each  file.     Pre- 
scription files  will  be  subject  to  inspection  by  inspectors  and  the 
medical  officer  in  charge  at  all  times. 

139.  In  connection  with  file  1,  an  alcohol  and  narcotic  record  will 
be  kept  of  the  dispensary  receipts  and  expenditures  of  each  article 
specified  therein.    A  separate  slip  will  be  kept  for  each  form  in  which 
the  liquor  or  drug  is  supplied,  as  "  Cocaine  hydrochlorate  powder  " 


24 

or  "Coaine  hydrochlorate  10-mgm.  hypo,  tablets."  The  date  of 
receipt  thereof  from  the  storeroom  and  the  amount  will  be  noted. 
The  expenditure  will  be  noted  by  entering  the  prescription  number 
and  the  amount  expended  in  compounding  the  prescription.  At  least 
once  a  month  the  slips  will  be  balanced,  and  the  quantities  remaining 
on  hand  will  be  verified  by  the  materiel  officer  and  the  facts  noted 
over  his  signature.  Form  1903-B  will  be  used  for  this  purpose. 

140.  A  competent  employee  will  be  in  charge  of  the  laundry,  under 
the  direction  of  the  materiel  officer.    He  will  see  that  a  proper  system 
of  linen  exchange  is  in  operation  and  that  all  soiled  linen  delivered  to 
the  laundry  is  carefully  checked.    He  will  require  all  soiled  linen  to 
be  properly  listed  by  ward  employees  before  its  delivery  to  the  laun- 
dry.   Employees  will  attend  to  this  exchange,  and  not  delegate  the 
work  to  patients.    Laundry  hampers  in  the  various  wards  will  be 
used  for  the  storage  of  soiled  linen  and  for  carrying  the  same  to  the 
linen  room.    Clean  linen  will  not  be  put  in  these  hampers  for  return 
to  wards. 

141.  The  laundry  office  will  always  have  an  ample  reserve  supply 
of  clean  linen  on  hand  for  the  purpose  of  exchange.    When  launder- 
ing is  not  done  in  the  hospital,  a  careful  check  will  be  made  and  a 
receipt  obtained  before  its  delivery  to  the  contract  laundry.     A 
second  check  will  be  made  upon  its  return. 

142.  The  hospital  laundry  comprises:  (1)  The  linen,  clothing,  and 
bedding  belonging  to  the  Public  Health  Service ;  (2)  the  underwear, 
hosiery,  and  handkerchiefs  of  patients  under  treatment  in  the  hospi- 
tal; (3)  the  underwear,  hosiery,  and  handkerchiefs  of  employees  en- 
titled to  laundering  under  the  terms  of  their  appointments;  (4)  the 
white  and  khaki  service  uniforms  which  are  soiled  in  the  course  of 
official  duty;   (5)   the  hospital  uniforms  of  nurses,  dietitians,  and 
aides. 

143.  Soiled  blankets,  spreads,  and  other  heavy  pieces  should  not  be 
allowed  to  accumulate,  but  should  be  Avashed  a  few  at  a  time  as  they 
become  soiled  so  as  to  equalize  the  work. 

144.  A  list  will  be  made  in  duplicate  of  each  patient's  clothing  by 
an  employee  in  the  ward  and  delivered  to  the  employee  in  charge  of 
the  linen  exchange  room,  who  will  receipt  for  the  same.    The  dupli- 
cate list  will  then  be  filed  with  the  patient's  clinical  record  and 
checked  against  the  clothing  upon  its  return. 

DIETETIC    SERVICE. 

145.  The  medical  officer  in  charge  will  maintain  constant  super- 
vision over  the  various  messes.    On  account  of  the  large  transactions 
incident  to  the  conduct  of  the  hospital  messes  and  the  opportunities 
afforded  by  them  for  irregular  or  dishonest  practices,  he  should  take 


25 

the  most  painstaking  care  when  detailing  employees  to  mess  manage- 
ment to  choose  only  those  of  known  probity  and  good  habits.  For  the 
same  reason  he  should  see  that  creditors  are  of  good  repute  and 
require  their  bills  to  be  promptly  rendered  at  the  end  of  every  month. 
Although  the  mess  may  be  under  the  direction  of  the  chief  dietitian, 
he  should  exercise  diligence  by  frequent  inspections  to  see  that  waste 
and  wrongful  expenditures  are  not  permitted,  and  that  the  messes 
are  so  managed  that  neither  patients  nor  personnel  shall  have  just 
grounds  for  complaint  concerning  the  character,  preparation,  and 
quantity  of  their  food. 

146.  When  the  chief  dietitian  is  authorized  to  make  purchases  of 
subsistence  supplies,  she  shall  be  held  strictly  responsible  for  their 
proper  disposition  and  for  the  quality  and  quantity  of  food  supplies 
in  the  hospital. 

147.  All  supplies  Avill  be  delivered  to  a  suitable  storeroom,  where 
they  will  be  properly  checked  upon  their  receipt  by  a  competent 
employee..   Issues  from  this  storeroom  to  the  various  messes  will  be 
made  daily  at  a  designated  hour  on  requisition  properly  signed  by  the 
employee  in  charge  of  the  mess  concerned.    No  supplies  will  be  issued 
at  any  other  time  except  in  extreme  emergency.    Supplies  so  issued 
will  be  listed  on  the  requisition,  giAdng  the  quantity  and  price  of  each 
article  and  the  total  value  of  food  supplies  furnished  daily. 

148.  The  employee  acting  as  storekeeper  for  the  central  supply 
room  under  the  direction  of  the  chief  dietitian  will  keep  a  daily 
record  of  the  total  articles  purchased  and  issued.    The  medical  officer 
in  charge  should  inspect  this  record  at  frequent  intervals  with  a  view 
to  keeping  constantly  informed  in  this  respect. 

149.  Food  supplies  for  the  preparation  of  between-meal  nourish- 
ment will  not  be  issued  to  wards  in  excess  of  24-hour  requirements. 
Bread  and  butter  for  bed  patients  will  be  issued  to  wards  with  each 
meal. 

150.  The  chief  dietitian  in  general  charge  of  the  hospital  mess  will 
be  responsible  for  the  condition  and  cleanliness  of  the  kitchens  and 
Booking  utensils  in  the  various  messes,  the  discipline  of  the  kitchen 
force,  the  cleanliness  of  the  dining  rooms  and  discipline  of  patients 
and  personnel  therein,  the  serving  of  meals  to  ambulant  patients  and 
the  distribution  of  food  to  the  various  wards,  the  cleanliness  of  the 
napery  and  table  utensils  used  in  serving  the  food,  and  the  proper 
sterilization  of  such  equipment  upon  its  return  from  wards  contain- 
ing patients  suffering  from  communicable  diseases. 

151.  All  kitchen  and  dining  room  employees  shall  be  examined 
before  being  placed  on  duty,  or  as  soon  thereafter  as  practicable,  to 
determine  whether  they  are  carriers  of  disease. 

152.  A  ration  report  will  be  prepared  at  the  end  of  every  month 
and  submitted  by  the  chief  dietitian  to  the  medical  officer  in  charge. 


26 

153.  The  chief  dietitian  in  charge  of  the  hospital  mess  shall  have 
authority  over  all  personnel  employed  in  that  department,  and  over 
all  ambulant  patients  in  dining  rooms  of  the  hospital. 

154.  The  chief  dietitian  will  prepare  menus  for  all  messes  in  the 
hospital,  and  will  submit  them  to  the  medical  officer  in  charge  for  his 
approval.    Menus  should  be  submitted  one  day  previous  to  their  use 
in  order  that  the  necessary  changes  can  be  made  before  diets  are  pre- 
pared. 

155.  The  officer  or  dietitian  responsible  for  the  purchase  of  sub- 
sistence stores  shall  be  furnished  if  possible  with  motor  transporta- 
tion for  the  purpose  of  proceeding  to  markets  to  make  such  purchases. 

156.  The  status  of  the  chief  dietitian  will  be  the  same  as  that  of 
the  chief  nurse.    In  all  matters  pertaining  to  conduct  and  discipline, 
dietitians  will  observe  the  same  regulations  as  nurses  and  aides  in 
the  hospital. 

157.  Dietitians  will  be  furnished  with  quarters  in  the  hospital  if 
such  quarters  are  available  for  women.    After  the  chief  nurse,  the 
chief  dietitian  will  be  given  preference  in  this  respect,  as  it  is  neces- 
sary that  she  be  on  duty  at  an  early  hour. 

PROFESSIONAL  SERVICES. 

158.  In  type  "A"  hospitals  the  professional  work  of  hospitals  will 
be  divided  as  follows:  (1)  Medical  service;  (2)  surgical  service;  (3) 
laboratory  service;   (4)  dental  service.     Each  of  these  departments 
will  be  under  the  supervision  of  a  chief  of  service. 

159.  In  type  "  B  "  hospitals  all  professional  work  of  the  hospital 
will  be  under  the  supervision  of  one  medical  officer,  who  will  be  desig- 
nated as  the  clinical  director.    He  will  be  charged  with  all  the  duties 
and  responsibilities  of  chiefs  of  service  in  type  "A"  hospitals. 

160.  In  type  "  C"  hospitals  the  professional  work  of  the  hospital 
will  be  under  the  immediate  supervision  of  the  medical  officer  in 
charge. 

161.  Chiefs  of  service  and  clinical  directors  will  be  responsible  for 
the  efficient  regulation  of  their  services,,  and  will  have  charge  of 
the  personnel  assigned  to  them.     They  will  keep  a  roster  of  all 
officers  as  assigned,  submitting  reports  to  the  medical  officer  in  charge 
as  required  on  the  conduct  and  efficiency  of  such  officers.    They  will 
assign  their  assistants  to  their  duties,  and  will  arrange  for  the  ad- 
mission of  patients  to  suitable  wards  and  their  proper  care  and  treat- 
ment therein.    They  will  make  frequent  visits  and  inspections  of  the 
wards  and  departments  comprising  their  services  and  consult  with, 
instruct,  and  advise  their  junior  officers. 

162.  Chiefs  of  service  and  clinical  directors  are  assistants  and  ad- 
visers of  the  medical  officer  in  charge,  and  will  freely  consult  with  him 


27 

in  all  mutters  affecting  the  policy,  administration,  and  conduct  of 
their  services.  They  will  confer  with  him  regarding  all  cases  of 
unusual  occurrence  and  any  matters  that  might  bring  discredit  upon 
the  station  and  the  service,  and  will  exert  every  effort  to  aid  in  con- 
ducting the  hospital  efficiently  and  in  accordance  with  regulations. 
A  list  of  seriously  ill  patients  will  be  kept  by  chiefs  of  service  for 
reference,  and  an  immediate  report  to  the  officer  in  charge  of  the 
records  of  patients  will  be  made  in  all  cases  of  critical  illness  or  death. 

163.  In  type  "A"  hospitals  all  communications  between  chiefs  of 
service  not  strictly  professional  in  character  will  pass  through  the 
office  of  the  executive  officer,  and  all  communications  or  reports  from 
wards  and  junior  officers  to  other  departments  will  pass  through  the 
chiefs  of  service  concerned  unless  otherwise  directed. 

164.  Chiefs  of  service  will  be  considered  as  general  consultants  in 
type  "A"  hospitals,  and  will  render  such  service  in  all  cases  where 
their  advice  may  be  required.    In  type  "  B  "  and  type  "  C  "  hospitals, 
as  a  general  rule,  the  services  of  local  physicians  appointed  as  at- 
tending specialists  will  be  utilized. 

MEDICAL    SERVICE. 

165.  The  medical  service  will  include  the  general  medical  wards, 
tuberculosis  ward,  isolation  ward  for  contagious  diseases,  and  the 
neuro-psychiatric  ward.     The  professional  personnel  of  this  service 
will  consist  of  a  chief  of  service  and  the  necessary  number  of  ward 
surgeons  and  internes. 

TUBERCULOSIS   WARD. 

166.  All  hospitals  of  the  service  shall  be  prepared  to  receive  at  least 
for  temporary  periods,  tuberculous  patients,  and  no  such  patients 

•  shall  be  refused  admission  to  any  hospital  of  the  service  because  of 
lack  of  special  facilities,  nor  discharged  for  that  reason.  An  officer 
known  to  be  skilled  in  the  recognition  and  interpretation  of  the 
physical  signs  upon  which  physical  diagnosis  is  based  shall  be  in 
charge  of  the  tuberculous  patients. 

NEURO-rSYCHIATRIC    WARD. 

167.  An  officer  especially  qualified  in  the  work  will  be  detailed  in 
charge  of  the  neuro-ps37chiatric  ward.    If  it  is  found  that  the  treat- 
ment of  certain  psychopathic  patients  in  a  general  hospital  is  inad- 
visable, request  will  be  made  to  the  Surgeon  General  for  their  trans- 
fer to  one  of  the  special-service  hospitals  for  patients  of  this  class. 
The  care  and  treatment  of  neuro-psychiatric  patients  is  prescribed  in 
detail  in  article  V. 


28 

ISOLATION  WARDS. 

168.  Employees  detailed  for  duty  with  contagious  disease  in  isola- 
tion wards  will  sleep  in  separate  quarters  from  other  employees. 
Their  meals  will  be  served  at  their  quarters  by  an  employee  detailed 
for  the  purpose.     Dishes  will  be  thoroughly  sterilized  before  being 
returned  to  the  kitchen.     Nurses  on  duty  with  these  cases  will  be 
segregated  as  much  as  conditions  demand,  under  the  direction  of 
the  chief  nurse.     All  dishes,  silverware,  and  other  food  containers 
in  the  isolation  wards  will  be  kept  in  such  wards  and  not  allowed  to 
return  to  the  main  kitchen.     Diets  will  be  delivered  to  the  door  of 
the  ward  by  the  personnel  on  duty  in  the- patients'  mess  and  trans- 
ferred to  the  containers  kept  in  the  ward  for  this  purpose.     The 
original  containers  will  be  returned  to  the  general  mess  to  be  ster- 
ilized before  further  use.    All  patients'  clothing  will  be  disinfected 
before  being  sent  to  the  main  clothing  room.    Patients  and  person- 
nel, upon  finally  leaving  an  isolation  ward,  will  be  given  such  course 
of  disinfection  by  the  ward  surgeon  as  the  case  demands.    Upon  the 
vacating  of  a  room  by  a  patient  with  a  contagious  disease,  the  ward 
surgeon  Concerned  will  order  such  disinfection  and  cleaning  as  may 
be  deemed  necessary. 

169.  No  person  except  employees  and  nurses  on  such  duty  and  med- 
ical officers  of  the  hospital  will  be  allowed  to  enter  isolation  wards. 
Ward  surgeons  will  require  a  strict  enforcement  of  this  rule,  and 
will  permit  no  loitering  in  these  wards.     Officers  not  on  duty  in 
isolation  wards  will  not  be  permitted  to  enter  the  same  without  the 
permission  of  the  chief  of  the  jnedical  service. 

170.  Nurses  and  attendants  will  not  be  detailed  for  duty  in  the 
surgical  service  for  at  least  10  days  after  their  relief  from  duty 
with  cases  of  scarlet  fever  or  erysipelas.    Nasal  and  pharyngeal  cul- 
tures will  be  made  twice  weekly  from  medical  officers,  nurses,  and 
employees  on  duty  with  cases  of  meningitis  and  diphtheria.     If  a 
positive  culture  is  found  at  any  time  the  person  will  be  isolated  and 
appropriate  treatment  given  until  three  successive  negative  cultures 
are  obtained. 

171.  In  addition  to  the  methods  employed  in  the  segregation  of 
highly  contagious  diseases,  all  cases  of  whatever  character  in  which 
the  disease  is  communicated  by  the  secretions  of  the  nasal,  oral, 
pharyngeal,  or  bronchial  mucous  membrane  will  be  so  separated  in 
wards  by  sheets  or  screens  as  to  prevent  cross  infection.    This  will 
also  be  done  in  cases  of  empyema  and  other  surgical  infections. 

172.  Patients  with  communicable  diseases  shall  not  be  permitted  to 
handle  food,  dishes,  or  other  articles  used  by  other  patients. 


29 

SURGICAL  SERVICE. 

173.  The  surgical  service  will  include  the  sections  of  general  sur- 
gery, eye,  ear,  nose,  and  throat,  orthopedic  surgery,  and  urology. 
The  personnel  in  this  service  will  consist  of^a  chief  of  service  and  the 
necessary  number  of  ward  surgeons  and  internes. 

174.  The  chief  of  service  will  ordinarily  act  as  surgical  consultant 
and  as  operating  surgeon  under  the  direction  of  the  medical  officer 
in  charge.     He  will  be  responsible  to  the  medical  officer  in  charge 
for  the  performance  of  all  operative  procedures,  and  will  forward 
a  report  to  the  officer  in  charge  of  the  records  of  patients  in  every 
case  before  operations  dangerous  to  life  are  performed.    He  will  be 
responsible  for  the  proper  conduct  of  all  sections  included  under  this 
service,  and  will  make  such  inspections  and  require  such  reports  as 
may  be  necessary. 

175.  No  medical  officer  on  the  surgical  staff  will  actively  participate 
in  any  post-mortem. 

176.  Before  operative  procedures  are  instituted,  the  written  consent 
of  the  patient  shall  be  obtained  in  every  case  and  filed  as  a  part  of  his 
clinical  record. 

177.  The  general  operating  room  will  be  available  for  immediate 
use  at  all  hours. 

EYE,  EAR,  NOSE,  AND  THROAT  DEPARTMENT. 

178.  In  type  "A"  hospitals  this  service  will  be  conducted  under  the 
separate  sections  of  ophthalmology  and  oto-laryngology,  with  suit- 
able officers  in  charge  of  each  section. 


179.  In  type  "A"  hospitals  this  service  will  be  conducted  under  the 
separate  section  of  urology,  with  an  officer  especially  qualified  in  this 
work  in  charge.    He  will  give  such  instructions  to  employees  and  to 
patients,  and  initiate  such  procedures  as  are  considered  helpful  in  the 
control  of  venereal  diseases. 

180.  All  patients  suffering  from  venereal  disease  shall  be  segregated 
with  respect  to  wards,  mess  halls,  and  toilet  rooms.    Dishes  used  by 
venereal  patients  will  be  kept  separate  until  sterilized. 

WARD    SURGEONS. 

181.  Ward  surgeons  will  be  assigned  by  their  immediate  profes- 
sional chiefs,  and  under  their  authority  will  have  charge  of  the  wards 
to  which  assigned.     They  will  be  responsible  for  the  treatment,  in- 


30 

struction,  care,  and  well-being  of  all  patients  therein ;  for  the  proper 
performance  of  duties  of  nurses  and  other  employees  and  a  strict 
compliance  with  regulations ;  for  the  proper  equipment  of  the  wards 
and  for  the  public  property  therein;  for  the  condition  of  such 
property  and  the  economical  use  of  all  Government  supplies  and  ma- 
terial; for  the  preparation  of  complete  and  accurate  clinical  records 
in  all  cases ;  and  for  the  discipline  and  general  conduct  of  the  ward. 

182.  Patients  received  in  a  ward  will  be  examined  at  once  by  the 
ward  surgeon.    He  will  note  on  the  clinical  record  the  exact  hour  and 
minute  his  first  examination  is  made. 

183.  In  the  event  that  the  effects  of  a  patient  have  not  already  been 
cared  for,  the  ward  surgeon  will  personally  take  charge  of  all  money 
and  valuables,  deliver  the  same  to  the  officer  in  charge  of  patients' 
effects,  and  obtain  a  receipt  for  the  patient.     He  will  see  that  the 
clothing  of  patients  is  properly  cared  for  by  the  head  nurse. 

184.  Clinical  records  of  all  cases  will  be  begun  as  soon  as  practi- 
cable after  admission.     They  must  show  an  accurate  and  concise 
record  of  the  patient's  past  history,  condition  on  admission,  daily 
notes  upon  condition  and  treatment  while  in  the  hospital,  and  condi- 
tion upon  the  close  of  the  case.    Such  additional  pages  will  be  used 
as  the  importance  and  nature  of  the  case  demand.    Records  of  labo- 
ratory, physiotherapy,  occupational  therapy,  and  all  other  procedures 
will  be  attached  in  their  proper  places.    All  orders  for  treatment  will 
be  in  writing,  and  will  be  initialed  by  the  officer  prescribing  the  same. 

185.  Form  1971-F  will  be  used  by  ward  surgeons  for  reporting 
changes  of  diagnosis.    The  patient's  name  and  register  number  will 
be  recorded,  and  the  words  "  Change  of  diagnosis  "  inserted  under 
"  complication,  etc."    The  new  diagnosis  will  be  stated  by  name  and 
number,  and  the  report  properly  signed  by  the  ward  surgeon  will  be 
immediately  forwarded  to  the  chief  of  service,  and  forwarded  by 
him  in  turn  to  the  officer  in  charge  of  the  records  of  patients.     A  like 
report  will  be  made  by  ward  surgeons  upon  the  occurrence  of  a  com- 
plication, sequela,  intercurrent  disease,  operation,  or  death,  the  fact 
in  each  case  being  recorded  under  the  appropriate  heading.     No 
condition  should  be  recorded  as  an  intercurrent  disease  which  is  in 
any  way  dependent  upon  the  original  cause  of  admission. 

186.  Ward  surgeons  will  designate  the  diet  for  each  patient  and 
will  see  that  the  same  is  noted  on  the  clinical  record  by  the  head 
nurse.    The  total  amounts  for  24  hours  will  be  stated  on  liquid  und 
semiliquid  diets. 

187.  When  patients  are  sent  to  appear  before  boards  or  other  de- 
partments of  the  hospital  for  examination,  diagnosis,  or  treatment,  the 
necessary  charts  and  clinical  records  will  be  forwarded  to  the  officer 
concerned,  who  will  enter  the  findings  and  treatment  on  the  clinical 
record  before  its  return. 


31 

188.  In  case  of  transfer  from  one  ward  to  another,  the  record  will 
be  completed  to  date,  the  exact  time  and  the  ward  to  which  trans- 
ferred Avill  be  noted,  and  history  so  completed  will  be  sent  with  the 
patient  in  the  care  of  an  employee.    Under  no  conditions  will  patients 
be  permitted  to  handle  their  own  clinical  records. 

189.  When  a  patient  dies,  is  discharged,  or  transferred  to  another 
hospital,  all  sheets  of  the  clinical  record  will  be  completed,  arranged 
in  proper  sequence,  and  fastened  together.     The  ward  surgeon  will 
sign  the  record  in  the  proper  place  and  forward  it  to  the  chief  of 
service,  who  will  make  a  careful  check  of  all  entries  and  forward  it  in 
turn  to  the  officer  in  charge  of  clinical  records. 

190.  Clinical  records  will  not  be  removed  from  the  ward  where  a 
patient  is  receiving  treatment  except  by  authority  of  the  chief  of 


service. 


. 

191.  Ward  surgeons  will  not  transfer  patients  from  one  ward  to 
another  without  the  authority  of  their  immediate  chiefs.    After  such 
transfers  have  been  approved,  the  approval  shall  be  countersigned  by 
the  admitting  officer  before  the  transfer  is  made. 

192.  Under  immediate  necessity  emergency  transfers  may  be  made 
by  ward  surgeons  OT  the  officer  of  the  day,  but  a  report  of  the  action 
taken  must  be  made  at  the  earliest  possible  moment  to  the  chief  of 
service  concerned  and  to  the  admitting  officer.    Emergency  transfers 
will  not  be  made  except  for  sound  and  justifiable  reasons.    In  type  "A" 
hospitals  the  transfer  of  patients  from  one  service  to  another  will  be 
made  only  with  approval  of  both  chiefs  of  service. 

193.  All  cases  of  serious  illness  will  be  reported  to  the  chief  of 
service  for  consultation.    A  daily  report  of  all  patients  likely  to  need 
treatment  during  the  night  will  be  made  by  ward  surgeons  to  the 
officer  of  the  day.    In  all  cases  liable  to  germinate  in  death,  the  name 
and  address  of  the  relative  or  persons  to  be  notified  in  case  of  emer- 
gency will  be  verified. 

194.  When  a  member  of  the  personnel  oil  duty  in  a  hospital  is  ad- 
mitted to  a  ward  as  a  patient,  the  ward  surgeon  must  report  the  fact 
to  the  admitting  officer  and  to  the  personnel  officer.     It  will  not  be 
necessary  in  emergency  cases  to  actually  take  such  patients  to  the 
admitting  station,  but  the  necessary  data  must  be  furnished  to  that 
office  promptly  so  that  the  patients  may  be  taken  up  in  the  proper 
manner. 

195.  Ward  surgeons  will  be  responsible  for  the  correctness  and 
prompt  delivery  of  ward  reports  to  the  chief  of  service  for  transmis- 
sion to  the  officer  in  charge  of  the  records  of  patients. 

196.  Upon  the  death  of  a  patient,  the  ward  surgeon  shall  immedi- 
ately notify  the  officer  of  the  day. 


32 

197.  If  autopsy  is  desired,  a  -written  request  for  the  same,  approved 
by  the  medical  officer  in  charge,  will  be  forwarded  to  the  officer  in 
charge  of  the  laboratory  service,  after  consent  of  the  nearest  relation 
shall  have  been  obtained. 

198.  Death  certificates  for  local  authorities  shall  bear  the  initial  of 
the  ward  surgeon  in  charge  of  the  case,  but  shall  be  signed  by  the 
medical  officer  in  charge. 

199.  Ward  surgeons  will  exercise  economy  in  their  ward  prescrip- 
tions and,  if  possible,  limit  the  quantity  of  the  mixture  or  drug  to 
100  grams  at  a  time,  excepting  liniments  and  lotions. 

200.  Convalescent  patients  may  be  permitted  to  perform  such  light 
duty  about  the  wards  as  may  not  be  injurious  to  their  health.     Ward 
surgeons  will  designate  such  patients  and  the  duties  they  may  per- 
form, the  head  nurse  noting  the  same  on  the  patient's  clinical  record. 

201.  Patients  will  not  be  given  passes  to  leave  the  hospital  except 
by  permission  of  the  ward  surgeon  concerned,  under  the  general  rules 
instituted  by  the  medical  officer  in  charge. 

202.  The  duties  and  responsibilities  of  ward  surgeons  \vith  regard 
to  service  property  are  prescribed  in  Article  XIV. 

LABORATORY   SERVICE. 

203.  The  chief  of  this  service  in  type  "A"  hospitals  will  have 
charge  of  the  entire  laboratory  service,  including  the  chemical,  bacte- 
riological and  X-ray  laboratories  and  the  morgue. 

204.  The  laboratory  will  make  such  examinations  of  specimens  as 
are  requested  by  ward  surgeons  or  other  officers,  and  the  results  will 
be  reported  directly  to  the  officer  requesting  the  same,  on  the  proper 
page  of  the  clinical  record.     A  duplicate  of  the  finding  will   be 
retained  in  the  laboratory  in  every  case. 

205.  The  chief  of  the  laboratory  service  will  detail  a  medical  officer 
in  charge  of  the  morgue,  who  will  act  as  pathologist.     This  officer 
will  be  held  responsible  for  the  proper  conduct  of  all  autopsies  and 
for  the  records  pertaining  to  the  same.    The  officer  in  charge  of  the 
morgue  will  be  responsible  for  all  bodies  from  the  time  they, are 
delivered  to  the  morgue  until  they  are  turned  over  to  the  undertaker. 
All  bodies  will  be  examined  immediately  after  their  delivery  to  the 
morgue  to  see  that  they  have  been  properly  tagged  for  identification. 

206.  A  report  of  the  findings  of  each  autopsy,  signed  by  the  officer 
conducting  the  same,  will  be  inserted  in  the  proper  place  in  the  clini- 
cal record  of  the  deceased.     A  duplicate  of  this  report  will  be  kept 
on  file  in  the  morgue.     A  triplicate  copy  will  be  fonvarded  to  the 
Chief  Medical  Adviser  when  the  deceased  is  a  patient  of  the  Bureau 
of  War  Risk  Insurance. 

207.  All  medical  officers  on  duty  at  a  station  shall  be  present  at 
post-mortem  examinations  so  far  as  their  duties  will  permit. 


33 

208.  The  X-ray  section  will  be  under  the  immediate  charge  of  a 
medical  officer  or  qualified  roentgenologist,  who  will  be  assigned  for 
this  work  by  the  Surgeon  General.     Requests  from  ward  surgeons 
for  X-ray  examinations  will  be  submitted  upon  the  proper  page  of 
the  clinical  record,  and  such  requests  will  be  sufficient  authority  for 
the  use  of  the  apparatus,  but  due  judgment  will  be  exercised  in  for- 
warding such  requests  to  avoid  waste  of  material.     All  X-ray  records 
will  be  properly  filed  for  ready  reference. 

WARD    EMPLOYEES. 

209.  Ward  employees  will  act  as  assistants  to  the  head  nurse  in  all 
wards  in  which  female  nurses  are  on  duty.    They  will  be  responsible 
for  the  prompt  execution  of  all  orders  given  by  the  head  nurse  or  by 
the  ward  surgeon.    They  will  assist  in  every  way  possible  in  the  dis- 
cipline and  care  of  patients,  the  proper  cleanliness  of  the  wards,  and 
any  other  duties  that  may  be  required.    In  wards  in  which  no  female 
nurses  are  assigned  the  duties  of  ward  employees  wrill  be  the  same  as 
those  of  nurses.    In  such  wards  male  nurses  especially  qualified  will 
be  detailed  to  have  charge  of  the  nursing  service.     Male  nurses  in 
charge  of  wards  will  be  responsible  to  the  ward  surgeon  for  the  pub- 
lic property  therein. 

NURSING  SERVICE. 
CHIKF    NUKSE. 

210.  The  chief  nurse  will  be  under  the  immediate  orders  of  the 
medical  officer  in  charge  of  the  hospital. 

211.  The  chief  nurse  will  have  general  supervision  of  the  nursing 
service  in  all  wards,  operating  rooms,  and  dressing  rooms  in  which 
nurses  are  on  duty. 

212.  The  chief  nurse  will  familiarize  herself  w7ith  service  regula- 
tions, and  Avill  instruct  the  nurses  under  her  supervision  in  such  regu- 
lations as  refer  to  them  and  in  the  duties  peculiar  to  service  hospitals. 
When  required  by  the  medical  officer  in  charge,  she  will  supervise  the 
instruction  of  employees  on  duty  in  wards  in  practical  nursing. 

213.  The  chief  nurse  will  exact  the  proper  performance  of  their 
duties  by  all  nurses.    She  will  be  in  charge  of  the  nurses'  quarters. 
Although  the  chief  nurse,  chief  dietitian,  and  chief  aide  are  on  the 
same  basis  of  authority  so  far  as  control  in  their  respective  depart- 
ments is  concerned,  in  matters  pertaining  to  conduct  and  discipline 
in  the  nurses'  home  the  chief  nurse  is  in  charge  of  all  dietitians  and 
aides  as  well  as  nurses.    She  will  report  at  once  any  serious  breach  of 
discipline  upon  the  part  of  nurses,  aides,  and  dietitians  to  the  medical 
officer  in  charge. 

185279°— 20 3 


34 

214.  All  complaints,  resignations,  and  other  matters  concerning  the 
nurses  will  be  transmitted  to  the  medical  officer  in  charge  through 
the  chief  nurse. 

215.  It  shall  be  the  duty  of  the  chief  nurse  to  see  that  the  nurses 
under  her  supervision  cooperate  in  every  way  possible  with  the  chief 
dietitian  and  render  every  assistance  to  make  the  dietetic  service 
successful. 

216.  The  chief  nurse  will  be  responsible  for  the  comfort  and  gen- 
eral well-being  of  the  nurses  under  her  charge,  and  will  promptly 
report  to  the  medical  officer  in  charge  any  matters  which  unfavorably 
affect  the  same.    She  will  bring  to  his  attention  at  once  any  case  of 
illness  among  the  nurses. 

217.  The  chief  nurse  will  arrange  the  hours  of  duty  and  assignment 
of  all  nurses,,  and  will  be  responsible  for  the  execution  of  all  orders 
relating  to  such  assignments.     She  will  keep  a  roster  of  the  assign- 
ment of  nurses,  and  furnish  the  same  to  the  medical  officer  in  charge 
for  his  approval. 

218.  The  chief  nurse  shall  prepare  an  efficiency  report  of  all  nurses 
at  the  station  on  the  last  day  of  each  month,  such  report  to  include 
estimates  of  the  nurses'  professional  work,  physical  fitness,  and  apti- 
tude for  the  service.    Special  attention  should  be  paid  to  nurses'  effi- 
ciency reports  during  the  first  six  months  of  their  service,  which 
should  include  statements  as  to  the  executive  ability  shown  by  the 
nurses.     She  will  render  this  report  to  the  medical  officer  in  charge 
for  his  approval  and  transmission  to  the  Surgeon  General. 

SUPERVISING    NIGHT   Nt'RSE. 

219.  When  necessary,  the  chief  nurse  will  detail  a  nurse  to  super- 
vise the  nursing  service  of  the  hospital  at  night. 

220.  Ward  nurses  on  night  duty  will  respect  the  orders  of  the  super- 
vising night  nurse  accordingly.    They  will  apply  to  her  for  instruc- 
tions and  will  inform  her  at  once  of  all  emergency  cases  arising  in  the 
wards. 

221.  The  supervising  night  nurse  on  being  relieved  will  report  to 
the  chief  nurse  any  unusual  incidents  of  the  night's  work  and  any 
derelictions  of  duty  on  the  part  of  night  nurses  and  ward  employees. 

HEAJ>    NUKSES. 

222.  The  chief  nurse  will  designate  one  nurse  for  each  ward  to  act 
as  its  responsible  nursing  head. 

223.  The  head  nurse  will  be  in  charge  of  the  nurses,  the  employees, 
and  the  patients  in  her  ward,  under  the  direction  of  the  ward  sur- 
geon, and  will  be  respected  and  obeyed  accordingly. 


35 

224.  The  head  nurse  will  receive  from  the  ward  surgeon  all  orders 
relating  to  the  care  and  treatment  of  the  patients  in  her  ward,  and 
will  record  them  for  the  guidance  of  both  day  and  night  nurses. 
In  carrying  out  written  instructions  from  ward  surgeons  the  nurse 
Avho  executes  the  order  should  place  her  initials  on  the  order  for 
any  future  reference  that  may  be  necessary. 

225.  The  head  nurse  will  be  responsible  in  her  ward  for  the  proper 
nursing  of  patients,  the  proper  serving  of  food  in  the  ward,  the 
administering  of  medicine,  and  other  treatment  prescribed,  the  clean- 
liness and  order  of  the  ward,  and,  under  the  ward  surgeon,  for  the 
public  property  therein. 

226.  The  head  nurse  will  be  responsible  to  the  chief  nurse  for  the 
conduct  and  work  of  the  ward  nurses,  will  advise  the  chief  nurse 
concerning  their    efficiency,  and  will  report  upon  the  efficiency  of 
other  employees  in  the  ward  to  the  proper  authority. 

227.  The  head  nurse  will  secure  such  medicines  from  the  dispensary 
daily  as  are  directed  by  the  ward  surgeon,  except  alcohol,  alcoholic 
beverages,  and  habit-forming  drugs.    These  must  be  drawn  by  the 
ward  surgeon  or  other  medical  officer  personally,  and  delivered  to 
the  head  nurse,  except  in  an  emergency,  in  which  case  the  ward  sur- 
geon must  later  visit  the  dispensary  and  verify  the  transaction.     The 
head  nurse  will  keep  the  above-mentioned  class  of  drugs  under  lock 
and  key  at  all  times,  retaining  the  key  in  her  personal  possession. 

228.  The  head  nurse  will  keep  an  accurate  account  of  all  receipts 
and  expenditures  of  alcohol  and  alcoholic  beverages  and  habit-form- 
ing drugs.    This  account  will  be  balanced  monthly,  showing  the  bal- 
ance on  hand.    The  ward  surgeon  shall  verify  and  sign  this  account 
monthly,  and  report  any  discrepancies  to  the  medical  officer  in  charge. 

229.  The  head  nurse  will  supervise  each  morning  the  collection  of 
all  soiled  linen  and  its  delivery  to  the  laundrj^  office  at  the  required 
hour,  receiving  therefrom  clean  articles  in  exchange.     Bedding  will 
be  hung  out  to  air  once  each  week. 

230.  Patients  will  be  given  appropriate  admitting  baths  on  arrival 
at  the  ward,  and  will  be  bathed  at  least  twice  weekly  thereafter. 
Bed  patients  will  be  bathed  not  less  than  every  second  day. 

831.  Nurses  and  employees  on  duty  in  wards  will  have  no  financial 
dealing  with  patients,  and  should  the  head  nurse  discover  any  valu- 
ables or  money  belonging  to  a  patient,  she  will  report  the  matter 
to  the  ward  surgeon,  who  will  take  charge  of  the  same. 

232.  In  the  event  that  surplus  clothing  has  not  been  delivered  to 
the  storeroom  for  patients'  effects,  the  head  nurse  will  collect  and 
check  the  same  as  soon  as  possible  after  the  arrival  of  the  patient 
in  the  ward,  and  will  prepare  patients'  property  slips  in  duplicate 
us  required  by  regulations.  She  will  be  responsible  for  the  safe  de- 


36 

livery  of  the  clothing  and  property  slips  to  the  officer  in  charge  of 
patients'  clothing  room. 

233.  The  head  nurse  will  assist  the  ward  surgeon  in  his  monthly 
check  of  property  in  the  ward.    The  linen  storeroom  in  each  ward 
will  be  kept  in  a  clean  and  orderly  condition  and  will  be  locked 
at  all  times  with  the  key  in  her  possession. 

234.  All  temperature  books,  order  books,  and  other  ward  records 
will  be  prepared  under  the  direction  of  the  head  nurse. 

235.  Form  1971-H,  containing  the  name  of  the  patient,  register 
number,  permanent  address,  and  name  and  address  of  nearest  rela- 
tive, shall  be  attached  by  the  head  nurse  to  the  foot  of  each  bed. 

236.  The  head  nurse  will  exercise  care  to  prevent  special  diet  cases 
from  going  to  the  mess  hall  with  ambulant  patients.     She  will  see 
that  no  food  delivered  to  the  wards  is  eaten  by  the  nurses  or  other 
employees  on  duty  therein. 

237.  The  head  nurse  will  prepare  daily  Form  1920-A,  Consolidated 
Diet  Slip,  which  will  be  signed  by  the  ward  surgeon  and  forwarded  to 
the  dietitian  at  a  designated  time. 

238.  No  food  supplies  will  be  kept  in  wards  in  excess  of  24-hour 
requirements.    Requisition  for  necessary  ingredients  for  the  prepara- 
tion of  between-meal  nourishments  will  be  included  in  the  Consoli- 
dated Diet  Slip  each  morning.    When  emergency  diet  slips  are  sent 
to  the  dietitian,  they  must  be  accompanied  by  an  explanation,  signed 
by  the  ward  surgeon. 

NUESES. 

239.  The  duties  of  nurses  shall  be  such  as  is  usually  performed  by 
trained  nurses  in  civil  hospitals  of  like  character.    So  far  as  practi- 
cable their  tour  of  duty  shall  not  exceed  eight  hours  a  day.    They 
will  not  be  required,  except  under  stress  of  emergency,  to  serve  more 
than  one  month  in  three  on  night  duty. 

240.  Day  nurses  are  at  all  times  responsible  to  head  nurses  for  the 
proper  service  in  the  wards.    Night  nurses  are  responsible  during  the 
night  to  the  supervising  night  nurse,  if  there  is  one ;  otherwise  they 
are  directly  responsible  to  their  respective  head  nurses  for  the  night 
service  in  the  wards.     In  either  event  the  night  nurses  on  being 
relieved  by  the  day  nurses  will  make  written  reports  of  their  work 
to  the  head  nurses. 

241.  A  nurse  will  not  be  permitted  to  absent  herself  from  duty 
until  her  relief  nurse  has  arrived,  nor  will  any  nurse  be  allowed  to 
return  to  the  wards  during  her  hours  of  leave,  except  with  the  per- 
mission of  the  chief  nurse,  which  must  be  obtained  in  every  instance. 
No  nurse  will  be  permitted  to  absent  herself  from  the  ward  during 
meal  time  without  proper  relief. 

242.  In  their  relations  with  patients  nurses  will  at  all  times  main- 
tain a  strictly  professional  attitude. 


37 

DENTAL  SERVICE. 

243.  The  personnel  of  this  service  in  type  A  hospitals  shall  consist 
of  a  chief  of  the  dental  service,  and  the  necessary  number  of  officers 
and  assistants.    The  chief  of  the  dental  service  will  ordinarily  act  as 
consultant  on  all  oral  conditions,  and  as  operating  dental  surgeon 

'  under  the  immediate  direction  of  the  medical  officer  in  charge  of  the 
hospital.  He  shall  be  responsible  to  the  medical  officer  in  charge  of 
the  hospital  for  the  proper  conduct  of  this  service  and  for  the  per- 
formance of  all  operative  proeedures.  He  shall  make  such  inspec- 
tions and  require  such  reports  as  may  be  necessary.  The  necessary 
dental  employees  will  be  detailed  for  duty  in  the  various  operating 
rooms  and  laboratories. 

244.  Dental  officers  shall  be  responsible  for  the  treatment,  instruc- 
tion, care,  and  well-being  of  all  patients  assigned  to  them;  for  the 
proper  performance  of  duties  by  nurses,  assistants,  and  other  em- 
ployees; for  a  strict  compliance  with  regulations ;  for  the  proper  care 
of  equipment ;  for  the  proper  use  of  dental  supplies  and  equipment ; 
and  for  the  preparation  of  complete  and  accurate  dental  clinical 
records  of  cases  assigned  to  them  by  the  chief  of  the  dental  service. 

245.  When  the  amount  of  work  justifies  the  same,  a  trained  dental 
assistant  or  graduate  nurse  shall  be  assigned  to  each  officer.     The 
duties  of  this  assistant  or  nurse  shall  be  the  sterilization  of  instru- 
ments, and  such  prophylactic  measures  as  shall  be  ordered  by  the  offi- 
cer to  whom  she  is  assigned. 

246.  The  patient  upon  entering  shall  receive  a  dental  record  chart 
from  the  employee  in  charge  of  dental  records.    A  dental  officer  will 
examine  the  patient,  execute  the  dental  record  chart,  and  be  respon- 
sible to  the  chief  of  the  dental  service  for  further  disposition  of  the 
case. 

247.  Records  of  dental  procedure  shall  be  full  and  complete  and 
must  be  entered  upon  the  dental  record  chart  at  the  time  the  opera- 
tion is  performed. 

248.  The  original  dental  record  chart  with  all  radiographic  diag- 
noses attached  shall  be  forwarded  to  the  Surgeon  General,  and  a  copy 
of  the  chart  will  be  returned  to  the  hospital  to  become  part  of  the 
patient's  clinical  record. 

RECONSTRUCTION  SERVICE. 

249.  The  reconstruction  service  will  be  responsible  for  the  admin- 
istration and  supervision  of  the  proper  application  of  all  curative 
measures,  other  than  the  actual  medical  and  surgical  treatment,  of 
all  patients  in  the  hospitals  of  the  service. 

250.  This  will  embrace  all  branches. of  physiotherapy,  occupational 
therapy,  which  includes  manual  handicrafts  and  mental  work  for 


functional  and  diversional  employment,  and  the  amusements  and 
recreations  of  the  patients  and  other  activities  under  the  direction 
of  the  Red  Cross. 

251.  It  is  the  duty  of  the  reconstruction  service  to  coordinate  and 
identify  the  reconstruction  work  with  that  of  the  medical  officer  re- 
sponsible for  the  medical  and  surgical  treatment  of  the  patient,  in 
order  that  the  best  possible  morale  may  be  established  and  the  resto- 
ration of  the  patient  to  functional  and  economic  usefulness  may  be 

.  hastened. 

BECONSTRUCTION  'OFFICER. 

252.  A  reconstruction  officer  will  be  assigned  for  duty  at  the  sev- 
eral hospitals  of  the  service.     Under  the  direction  of  the  medical 
officer  in  charge  he  will  be  in  charge  of  all  reconstruction  activities 
and  reconstruction  personnel  at  the  station.     He  will  be  either  a 
qualified  medical  officer  or  a  qualified  special  instructor  of  the  re- 
construction service. 

253.  If  a  medical  officer,  he  will,  at  the  request  of  and  in  consulta- 
tion with  the  ward  surgeon,  carefully  examine  each  patient  requiring 
physiotherapy  in  any  form  and  record  the  nature  and  degree  of  dis- 
ability.    He  will  reexamine  the  patient  at  intervals  and  record  the 
findings  over  his  signature  on  the  clinical  record. 

254.  He  shall  cause  a  survey  to  be  made  on  each  patient  witli  a 
view  of  determining  the  social  and  economic  status  of  the  patient 
and  the  possible  occupations  and  diversions  for  functional  restora- 
tion and  diversional  employment  that  will  be  of  most  interest  and 
benefit. 

255.  The  reconstruction  officer  will  keep  a  record  of  all  reconstruc- 
tion personnel  and  activities  of  the  hospital.    He  will  see  that  a  daily 
record  is  made  of  the  number  of  patients  enrolled  in  the  several  ac- 
tivities of  the  reconstruction  service.    The  name  of  the  patient,  the 
nature  and  number  of  treatments  or  time  in  hours  of  instruction  de- 
voted to  each  activity,  the  name  of  the  instructor  or  aide,  and  such 
other  facts  as  may  be  of  interest  will  be  recorded. 

256.  He  shall  make  a  weekly  report  of  reconstruction  activities 
and  a  monthly  report  of  reconstruction  personnel,  including  an  effi- 
ciency report  to  the  medical  officer  in  charge  for  transmittal  to  the 
Surgeon  General.    He  shall  supervise  the  preparation  of  the  daily  re- 
ports of  the  aides  and  the  records  of  the  patients.     He  shall  also 
make  such  other  reports  as  may  be  required  by  the  medical  officer  in 
charge. 

SPECIAL   INSTRUCTORS. 

257.  Special  male  instructors  will  supervise  and  administer  the 
several  branches  of  treatment  in  physiotherapy  or  shall  supervise, 
teach,  and  work  in  the  several  technical  trades,  or  kindred  subjects, 


39 

considered  under  the  head  of  occupational  therapy.    They  shall  keep 
u  daily  record  of  the  work  done  by  them  or  under  their  direction. 


CHIEF  AIDES. 


258.  The  chief  aide  shall  assist  the  reconstruction  officer  with  the 
administrative  and  executive  duties  of  the  reconstruction  service,  and 
will  act  in  all  matters  of  discipline  concerning  reconstruction  aides 
subject  to  the  supervision  of  the  chief  nurse. 


HEAD  AIDES  IN  PHYSIOTHERAPY. 


259.  Under  the  direction  of  the  reconstruction  officer,  head  aides 
in  physiotherapy  shall  instruct  and  supervise  the  physiotherapy  aides 
in  the  performance  of  their  duties,  and  shall  administer  the  treatments 
of  physiotherapy  whenever  circumstances  require. 


AIDES    IN    PHYSIOTHERAPY. 


260.  Under  the  immediate  direction  of  head  aides,  aides  in  physio- 
therapy shall  administer  the  treatments  of  physiotherapy,  and  shall 
keep  a  daily  record  of  the  work  done  by  them. 


IN    PHYSIOTHERAPY. 


261.  Under  the  supervision  of  the  head  aide,  pupil  aides  in  physio- 
therapy will  assist  in  administering  the  'treatments  of  physiotherapy. 


SPECIAL    EMPLOYEES. 


262.  Special  male  employees  will  be  assigned  to  administer  special 
treatments  of  physiotherapy  and  instruction  in  occupational  therapy, 
and  shall  keep  daily  records  of  the  work  done  by  them. 


UDES    IN    OCCUPATIONAL    THERAPY 


263.  Under  the  direction  of  the  reconstruction  officer,  head  aides  in 
occupational  therapy  shall  instruct  and  supervise  the  occupational 
aides  in  the  performance  of  their  duties,  and  shall  give  instructions 
in  occupational  therapy  whenever  circumstances  require. 


AIDES   IN    OCCUPATIONAL    THERAPY. 


264.  Under  the  immediate  direction  of  the  head  aides,  aides  in 
occupational  therapy  shall  give  instructions  in  occupational  therapy, 
and  shall  keep  a  daily  record  of  the  work  performed. 


265.  Under  the  supervision  of  the  head  aide,  pupil  aides  in  occupa- 
tional therapy  shall  assist  in  giving  instructions  in  occupational 
therapy. 


40 

ARTICLE  V. 
NETTBO-PSYCHIATBIC  PATIENTS. 

266.  Persons  suffering  from  psychopathic  disorders  entitled  to  the 
benefits  of  the  service  may  be  admitted  to  the  psychopathic  ward  of 
a  general  hospital  or  to  a  special  hospital  maintained. by  the  service 
for  the  care  and  treatment  of  such  cases,  or,  with  the  approval  of  the 
Surgeon  General,  they  may  be  admitted  to  a  State  institution  of  the 
State  in  which  the  beneficiary  resides.     In  the  latter  instance  the 
laws  governing  the  admission  of  such  cases  to  those  institutions  must 
be  strictly  adhered  to. 

267.  A  mentally  disturbed  patient  who  is  a  beneficiary  of  the  serv- 
ice may  be  cared  for  temporarily  in  the  observation  ward  of  a  local 
hospital,  pending  the  approval  of  the  Surgeon  General  for  transfer  to 
a  hospital  maintained  by  or  under  contract  with  the  service.    Imme- 
diate report  of  such  action,  in  duplicate,  must  be  submitted  to  the 
Surgeon  General,  giving  the  reasons  therefor. 

268.  Inasmuch  as  many  of  the  neuro-psychiatric  ailments  are  of 
long  duration,  and  sufferers  therefrom  will  require  hospitalization 
for  a  considerable  period  of  time,  district  supervisors,  medical  offi- 
cers in  charge  of  hospitals,  and  others  concerned  will  exercise  due 
care,  before  a  neuro-psychiatric  patient  is  admitted  to  hospital,  that 
his  eligibility  to  treatment  "is  established  by  satisfactory  evidence. 
Special  care  must  be  taken  to  exclude  alien  paupers  and  others  not 
entitled  to  relief. 

269.  Drug  addicts  and  mental  defective  patients  of  the  Bureau  of 
War  Risk  Insurance  will  not  be  treated  at  stations  of  the  service  un- 
less evidence  is  submitted  that  they  have  received  an  award  of  com- 
pensation. 

270.  When  an  irresponsible  patient  is  to  be  admitted  to  hospital,* 
his  relatives  should  be  informed,  if  practicable,  and  their  acquies- 
cence in  the  arrangements  and  statement  of  preference  of  place  of 
treatment  secured. 

271.  The  medical  officer  in  charge  of  the  hospital  to  which  the 
patient  is  being  transferred  should  be  notified  in  advance. 

272.  The  term  "  shell  shock  "  will  not  be  used  in  reporting  diag- 
noses of  neuro-psychiatric  disorders.    Mild  mental  disorders  are  fre- 
quent sequelae  of  cerebrospinal  meningitis,  gassing,  and  other  con- 
ditions.   Great  care  should  be  exercised  in  the  observation,  treatment, 
and  hospitalization  of  all  such  cases. 

273.  It  is  of  great  importance  that  careful  study  be  made  of  every 
case  of  peripheral  nerve  injury  with  a  view  to  accurate  diagnosis 
and  appropriate  treatment. 


41 


274.  When  a  patient  has  recovered  his  normal  mental  state  he  may 
be  paroled  from  the  hospital  for  a  period  of  three  months  or  longer 
if  necessary. 

275.  During  the  period  of  this  parole  the  former  patient  shall  re- 
port to  the  medical  officer  in  charge  of  the  hospital,  either  in  writing 
or  in  person,  his  general  physical  and  mental  condition,  his  ability  to 
get  along  in  the  community,  and  other  personal  data  pertaining  to 
his  condition. 

276.  No  patient  of  the  Public  Health  Service  who  is  suffering 
from  a  mental  disorder  shall  be  paroled  or  discharged  into  the  com- 
munity until  by  conference  the  majority  of  the  medical  staff  of  the 
hospital  shall  acquiesce  in  writing  as  to  the  suitability  of  such  a  case 
for  parole  or  discharge.    Furthermore,  patients  shall  not  be  paroled 
or  discharged  to  the  custody  of  any  person  unless  that  person  is  the 
proper  one  to  assume  such  a  responsibility. 

277.  No  patient  of  the  service  shall -be  paroled  or  discharged  from 
any  neuro-psychiatric  hospital  or  psychopathic  ward  until  the  medi- 
cal officer  in  charge  has  satisfied  himself  that  the  locality  to  which  the 
patient  is  going  is  suitable  in  environment  for  such  a  patient.     More- 
over, the  medical  officer  in  charge  of  the  hospital  shall  see  that  all 
patients  who  are  paroled  or  discharged  from  his  care  are  properly 
and  seasonably  clothed  and  furnished  with  necessary  and  proper 
transportation  facilities. 

278.  The  organization  of  psychopathic  hospitals,  with  respect  to 
administrative  personnel,  shall  conform  to  that  of  general  hospitals 
of  the  same  bed  capacity. 

279.  The  organization  of  psychopathic  hospitals  with  respect  to 
professional  work  shall  correspond  in  general  to  that  of  type  B 
hospitals  of  the  service,  regardless  of  bed  capacity. 

280.  The  clinical  director  in  psychopathic  hospitals  shall  serve  as 
a  general  professional  assistant  to  the  medical  officer  in  charge,  and 
shall  supervise,  with  the  approval  of  the  latter,  such  medical,  moral, 
and  physical  treatment  as  in  his  judgment  will  be  best  adapted  to 
the  good  of  the  patients.     He  shall  obtain,  or  cause  to  be  obtained, 
as  far  as  possible,  a  complete  clinical  history  of  each  patient  in  the 
hospital.     Pie  shall  act  as  chief  of  the  medical  staff  and  have  super- 
vision and  control,  with  the. approval  of  the  medical  officer  in  charge, 
of  all  employees  who  have  to  do  with  the  care  and  treatment  of 
patients.     He  shall  also  preside  at  the  regular  staff  meetings. 

281.  Ward  surgeons  in  psychopathic  hospitals  will  inform  nurses 
and  attendants  of  suicidal,  homicidal,  or  otherwise  dangerous  tend- 
encies in  the  patients.     Thejr  shall  make  a  full  physical  and  mental 
examination  of  each  patient  within  24  hours  after  he  enters  the 
hospital,  and  prepare  such  data  as  are  necessary  to  present  the  case 


.      42 

at  the  regular  meeting.  In  the  examination  of  such  cases  special 
reference  shall  be  made  to  all  bruises  and  marks  appearing  on  the 
patient  at  that  time. 

282.  Ward  surgeons  are  expected  to  assist  in  devising  employment 
and  recreation  for  their  patients  and  to  do  everything  possible  to 
make  their  patients  comfortable  and  promote  their  recovery.     They 
will  keep  a  record  of  each  individual  case,  stating  conditions  from 
time  to  time,  and  noting  anything  that  may  be  of  particular  interest 
concerning  the  case  either  mentally  or  physically.    All  cases  of 
forced  alimentation  must  be  personally  attended  to  by  the  ward  sur- 
geon and  all  unnecessary  diets  and  medicines  promptly  discontinued, 
It  shall  be  the  duty  of  ward  surgeons  to  be  present  at  all  amusements 
and  entertainments,  and  to  attend  chapel  exercises  unless  excused 
by  the  medical  officer  in  charge. 

283.  The  duties  of  all  nurses  and  other  employees  of  the  hospitals 
maintained  for  the  care  and  treatment  of  psychopathic  disorders  are 
responsible  and  strictly  confidential,  and  most  cruel  wrongs  may  be 
inflicted  by  imprudent  disclosures  of  the  conduct  of  any  of  the 
patients.     Gossip  concerning  patients,  the  hospital,  or  its  employees 
to  persons  not  connected  with  the  institution  will  be  considered  suffi- 
c^ent  grounds  for  dismissal. 

284.  It  shall  be  the  duty  of  every  person  employed  to  check,  as  far 
as  possible,  all  conversation  or  allusions  on  the  part  of  patients  to 
subjects  of  obscene  or  improper  nature,  also  false  impressions  in  the 
minds  of  patients  concerning  their  treatment. 

285.  No  one  shall  assist  a  patient  in  any  clandestine  correspondence 
or  fail  to  report  same,  should  it  come  to  his  knowledge. 

286.  Xo  one  shall  assign  a  patient  for  detail  \vork  without  the  ap- 
proval of  the  ward  surgeon,  and  should  such  approval  be  granted 
it  is  not  to  extend  beyond  the  instance  specified.     Employees  de- 
tailed for  such  duty  are  expected  to  work  with  their  patients,  and 
to  report  those  not  properly  or  seasonably  clothed. 

287.  All  articles  which  may  be  considered  of  a  dangerous  character 
must  be  removed  from  the  person  of  an  insane  patient  and  delivered 
to  the  officer  in  charge  of  patients'  effects  at  the  time  of  admission. 

288.  Many  patients  entering  the  hospital  for  the  first  time  have 
fears  of  bodily  harm.    Everything  possible  should  be  done  to  dispel 
such  fears,  and  nurses  and  employees  must  be  cautioned  to  be  exceed- 
ingly careful  both  in  manner  and  language  toward  patients. 

289.  Everything  about  insane  patients  that  might  lead  to  danger- 
ous consequences  should  be  safely  guarded.    Dumb-waiter  doors,  bath- 
room doors,  dust-flue  doors,  and  everj^thing  of  this  character  must  be 
kept  locked.     Xurses  and  emplo3'ees  should  be  especially  vigilant 
that  patients  have  nothing  in  their  possession  that  can  be  used  as  a 


43 

weapon,  or  that  would  aid  in  their  escape.  Patients  suspected,  or 
those  known  to  be  in  the  habit  of  carrying  dangerous  implements,  or 
matches,  should  be  searched  and  their  rooms  also  searched. 

290.  It  is  the  duty  of  nurses  and  employees  to  take  all  nonparole 
patients  out  for  exercise  in  suitable  weather,  unless  they  are  excused 
from  going  by  the  ward  surgeon.    It  is  required  that  nurses  and  em- 
ployees taking  patients  out  for  exercise  count  them  upon  leaving  the 
ward,  and  again  upon  returning. 

291.  In  taking  nonparole  patients  out  of  the  hospital  buildings 
care  should  be  exercised  to  guard  them  from  the  curious  eyes  of 
strangers  and  visitors  to  the  institution.    In  case  strangers  approach, 
it  is  the  duty  of  attendants  to  request  their  departure  to  some  other 
part  of  the  grounds.    In  case  of  refusal,  the  fact  should  immediately 
be  reported  to  the  medical  officer  in  charge. 

292.  No  patient  shall  ever  be  permitted  to  remain  in  a  ward  with- 
out the  presence  of  a  nurse  or  employee ;  and,  if  unable  to  go  out  for 
exercise,  or  meals,  the  fact  should  be  reported  to  the  head  nurse,  and 
the  patient  left,  temporarily,  in  a  ward  where  there  is  a  nurse  or  em- 
ployee.   It  is  strictly  forbidden  that  nurses  or  employees  make  going 
out  with  patients  a  pretext  for  doing  errands  or  calls  for  themselves. 

293.  The  escape  of  a  nonparole  psychotic   patient   without   the 
knowledge  of  nurse  or  employee,  or  without  being  promptly  reported 
to  the  medical  officer  in  charge,  will  be  treated  as  culpable  negligence. 
Any  patient  who  may  cause  trouble  while  out  for  exercise  or  who 
may  attempt  to  escape  should  be  immediately  returned  to  the  ward 
in  as  gentle  a  manner  as  possible. 

294.  Nurses  and  employees  are  not  permitted  to  use  forced  feeding 
or  forced  medication  unless  an  officer  is  present. 

295.  Psychopathic  patients  should  be  encouraged  to  take  an  interest 
in  some  occupation,  and  those  persons  responsible  for  such  occupation 
should  work  with  them.    Nurses  should  strive  in  every  way  to  provide 
amusement  and  employment  for  their  patients.     When  attending 
amusements,  chapel  exercises,  or  any  other  gathering,  the  nurses  and 
employees  must  retain  charge  of  their  respective  patients,  keeping 
with  them  at  all  times  and  exercising  the  same  supervision  over  them 
as  if  they  were  with  the  patients  in  the  ward. 

296.  When  restraint  is  required,  it  should  be  applied  as  gently  as 
possible.    It  is  not  to  be  used  without  the  consent  of  the  ward  surgeon, 
unless  a  patient  should  become  violent  and  be  in  danger  of  hurting 
himself  or  others,  then  immediate  restraint  may  be  applied  and  tha 
ward  surgeon  notified.    No  day  or  night  nurse  or  employee  is  ever 
justified  in  applying  restraint  alone.    When  patients  are  placed  under 
restraint  or  in  seclusion  the  action  taken  shall  be  recorded  on  the 
clinical  record  over  the  signature  of  the  clinical  director. 


44 

297.  Patients  are  not  allowed  to  work  on  the  ward  without  the 
presence  of  an  employee.    Clothes-room  doors  and  bath-room  doors 
should  be  kept  locked,  except  when  an  employee  is  present. 

298.  The  ward  employee's  place  of  duty  is  on  the  ward  with  his 
patients.    During  the  time  the  patients  are  out  of  their  rooms,  em- 
ployees are  not  permitted  to  be  in  theirs,  except  for  a  momentary 
errand.    No  employee  shall  leave  his  ward  while  on  duty  without 
permission  from  the  ward  surgeon  or  head  nurse. 

299.  While  on  duty  during  the  day,  nurses  and  employees  are  ex- 
pected to  make  the  care  of  their  patients,  their  clothing,  and  the 
condition  of  the   wards  their  exclusive  business.     When  patients 
receive  visitors,  nurses  must  see  that  such  patients  are  properly 
clothed  for  the  interview.    When  patients  are  called  to  the  reception 
room,  it  is  the  duty  of  the  nurse  to  remain  during  the  interview, 
unless  excused  from  doing  so  by  the  ward  surgeon.     Such  excuse 
will  apply  only  to  the  instance  specified. 

300.  People  visiting  the  grounds  of  the  psychopathic  institutions 
will  not  be  allowed  to  loiter  about  the  windows  or  talk  to  the  pa- 
tients from  the  outside.    Nurses  noticing  that  patients  are  attract- 
ing the  attention  of  visitors  about  the  windows  of  the  hospital  will 
report  the  same  to  the  hospital  office  at  once. 

301.  Nurses  and  ward  attendants  are  required  to  remain  constantly 
in  the  dining  room  during  each  meal.    When  it  is  necessary  to  feed 
psychotic  patients  outside  the  dining  room,  knives  and  forks  are  not 
to  be  given  them.    The  greatest  care  should  be  exercised  that  knives 
and  other  articles  are  not  taken  from  the  dining  room  by  these  pa- 
tients.   As  a  precaution,  knives,  forks,  and  spoons  should  be  col- 
lected by  the  attendant  and  counted  after  each  meal  before  patients 
leave  the  table.    Should  an  article  be  missed,  all  patients  should  be 
searched  before  leaving  the  dining  room. 

302.  Every  precaution  must  be  taken  to  guard  against  fire.    Carry- 
ing matches  about  the. building  is  exceedingly  dangerous,  and  only 
safety  matches  will  be  allowed  in  psychopathic  hospitals. 

303.  In  case  of  fire,  the  head  nurse  on  the  ward  must  report  the 
fire  to  the  administration  office  and  assemble  her  patients  in  the 
hall  of  the  ward.    Special  care  should  be  exercised  to  see  that  no  one 
is  left  in  the  rooms  and  that  the  room  doors  are  locked.    If  there 
is  no  immediate  danger,  the  duty  nurse  or  employee  on  the  ward 
will  report  to  the  office  for  instruction,  the  head  nurse  always  re- 
maining with  the  patients. 

304.  Psychotic  patients  must  always  bathe  in  the  presence  of  an 
employee,  and  the  room  must  never  be  left  for  an  instant  by  the  em- 
ployee until  the  patients  are  out.    Patients  should  never  be  permitted 
to  enter  the  bath  tub  "until  the  water  has  been  tested  as  to  tempera- 
ture, and  has  been  turned  off.    The  hot  water  must  never  be  turned  on 


45 

while  the  patient  is  in  the  tub.  If,  at  any  time,  the  temperature  of 
the  water  or  room  is  not  suitable,  bathing  should  be  discontinued 
and  the  fact  reported  to  the  hospital  office.  Each  patient  must  be 
properly  dried  before  putting  on  his  clothes.  At  the  time  of  bath- 
ing special  attention  should  be  given  to  trimming  toe  and  finger 
nails. 

305.  The  hair  of  male  patients  should  be  cut  sufficiently  often  for 
good  appearance.    The  hair  of  female  patients  should  never  be  cut 
short,  and  permission  from  the  Avard  surgeon  must  be  obtained  in 
every  case. 

306.  No  psychotic  patient  is  permitted  to  shave,  bathe,  feed,  or 
dress  another,  or  in  any  way  assist  in  preserving  order  or  discipline 
among  his  fellow  patients. 

307.  During  the  sleeping  hours  of  the  night  the  safety  of  the  in- 
stitution and  its  property  are  committed  to  the  fidelity  of  the  night 
nurses.     To  their  faithfulness,  discretion,  and  watchfulness,  great 
importance  is  attached.    All  should  strive  to  give  their  full  atten- 
tion to  their  duty  that  they  may  guard  the  affairs  of  the  institution 
and  promote  the  welfare  of  its  patients. 

308.  The  night  supervising  nurse  shall  patrol  each  ward  once  every 
hour  during  the  night  and  report  to  the  chief  nurse  any  events  of 
unusual  interest  during  the  night  service.    Night  nurses  must  care- 
fully guard  any  patients  who  are  supposed  to  be  suicidal,  and  never 
fail  to  report  attempts  at  suicide.     Special  report  shall  be  made  to 
the  supervisor  of  all  patients  unusually  restless  or  troublesome,  and 
those  in  restraint  or  seclusion,  or  requiring  special  treatment. 

ARTICLE  VI. 
DISCIPLINE  OF  PATIENTS. 

309.  Patients  of  the  Public  Health  Service,  Avhen  undergoing  hos- 
pital or  sanatorium  care,  will  conform  with  the  usual  orders,  rules, 
and  usages  of  such  institutions.     Failure  to  do  so  will  constitute 
reason  for  dismissal,  but  as  they  are  wards  of  the  Government  they 
should  not  be  discharged  for  trivial  reasons.    A  patient  may  be  dis- 
charged at  any  time  for  disregard  of  hospital  rules  or  insubordina- 
tion provided  mild  disciplinary  measures  have  failed  and  the  pa- 
tient is  not  seriously  sick  and  is  physically  able  to  leave  the  station. 
Before  the  discharge  of  a  patient  for  insubordination,  an  investiga- 
tion should  be  made  as  to  his  mental  condition.    In  the  case  of  pa- 
tients of  the  Bureau  of  War  Risk  Insurance,  the  Chief  Medical  Ad- 
viser will  be  informed  by  telegram  of  the  contemplated  discharge, 
with  an  outline  of  the  facts  in  the  case,  24  hours  before  it  is  carried 
into  effect. 


46 

310.  In  all  cases  of  dismissal  for  insubordination  a  report  shall  be 
sent  to  the  Surgeon  General  and  to  the  supervisor  of  the  district 
from  which  the  patient  was  received,  giving  the  patients  register 
number,  name,  age,  date  of  admission,  date  of  discharge,  and  the 
reasons  in  detail  for  the  dismissal.     The  causes  leading  up  to  the 
discharge  must  be  investigated  by  a  board  of  two  medical  officers 
detailed  for  the  purpose  by  the  medical  officer  in  charge,  and  the 
report  shall  be  signed  by  both  members  of  the  board.    If  the  patient 
is  a  beneficiary  of  the  War  Risk  Insurance  Bureau,  a  like  report  will 
be  sent  to  the  Chief  Medical  Adviser,  so  that  other  hospitalization 
may  be  arranged  should  it  be  necessary. 

311.  In  case  it  is  believed  necessary  to  take  advantage  of  dis- 
ciplinary action  authorized  under  the  war-risk  insurance  act,  or  its 
amendments,  particularly  with  respect  to  the  payment  of  compensa- 
tion, the  case  should  be  laid  before  the  Director  of  the  Bureau  of 
War  Risk  Insurance  with  full  report  and  recommendations. 

312.  A  patient  may  be  discharged  from  a  hospital  at  his  own  re- 
quest at  any  time  before  recovery.     In  such  event  a  statement  in 
writing  should  be  obtained  from  the  patient  to  the  effect  that  he  has 
been  discharged  at  his  own  request  contrary  to  the  advice  of  the 
medical  officer  in  charge. 

313.  If  a  patient  refuses  to  submit  himself  for,  or  in  any  way 
obstructs  any  examination,  the  case  will  be  reported  to  the  Bureau 
of  War  Risk  Insurance  for  appropriate  action.     .;',..  • 

ARTICLE  VII. 
DECEASED  PATIENTS. 

314.  The  body  of  a  deceased  patient  shall  under  no  circumstances 
be  removed  from  the  bed  until  a  medical  officer  has  pronounced  him 
dead.    Upon  the  death  of  a  patient  while  under  the  charge  of  the 
service  an  official  telegram  will  be  sent  to  the  nearest  relative  of  the 
deceased,  advising  him  of  the  fact. 

315.  Medical  officers  in  charge  shall  detail  an  officer  to  inspect 
bodies  of  deceased  patients  that  have  been  delivered  to  an  under- 
taker.    Officers  so  detailed  shall  make  a  careful  inspection  for  the 
purpose  of  determining  that  the  body  is  properly  clothed  and  pre- 
pared for  burial  or  shipment,  and  shall  report  the  results  of  their 
inspection  to  the  medical  officer  in  charge. 

316.  The  money,  valuables,  and  other  effects  of  the  deceased  will 
be  collected  by  the  officer  in  charge  of  patients'  effects,  who  will  for- 
ward the  same  to  the  legal  representative  of  the  deceased.     Money 
and  valuables  must  always  be  sent  by  registered  mail  or  express,  and 
only  after  consent  of  the  legal  representative.     Duplicate  copies  of 
the  patient's  property  slip,  Form  1971-J,  with  a  space  provided  for 


47 

receipt  by  the  legal  representative  will  be  inclosed  with  the  envelope 
containing  the  money  and  valuables,  and  when  the  receipt  has  been 
returned  it  will  be  filed  at  the  station. 

317.  The  money  and  valuable  effects  of  deceased  seamen  whose 
heirs  reside  abroad  shall  be  delivered  to  the  proper  consular  officer, 
and  the  money  and  valuable  effects  of  officers  or  enlisted  men  of  the 
Army  or  Navy  dying  while  under  the  care  of  an  officer  of  the  service 
shall  be  held  subject  to  the  order  of  the  commanding  officer  of  the 
nearest  Army  or  Navy  post,  a  receipt  being  taken  in  each  case  and 
filed.     All  receipts  shall  be  in  duplicate  and  the  duplicate  copy 
forwarded  to  the  Surgeon  General. 

318.  Patients  who  die  in  hospitals  or  sanatoria  of  the  United  States 
Public  Health  Service  may  be  buried  at  the  stations  at  an  expense  not 
to  exceed  $100,  chargeable  to  the  service.    At  relief  stations  at  which 
contracts  for  burial  are  in  effect,  the  service  shall  be  performed  by  the 
service  contractor  under  the  terms  of  his  contract  and  at  the  contract 
price,  otherwise  the  cost  of  burial  must  be  commensurate  writh  the 
service  rendered,  and  vouchers  for  the  same  must  bear  upon  their  face 
a  satisfactory  explanation  as  to  the  reasonableness  of  the  charge. 
Although  a  maximum  of  $100  is  set,  it  is  not  the  intention  that  $100 
should  be  paid  in  each  instance. 

319.  When  a  disabled  person  to  whom  compensation  is  payable 
under  the  provisions  of  Article  III  of  the  war  risk  insurance  act  is 
sent  by  the  direction  of  the  Bureau  of  War  Risk  Insurance  to  a  hos- 
pital or  sanatorium  for  treatment,  as  provided  in  paragraph  3  of 
section  302  of  said  act,  and  dies  in  said  hospital  or  sanatorium,  the 
reasonable  and  necessary  expense  of  transporting  the  body  of  the 
deceased  person  to  his  former  home  may  be  paid  by  the  Bureau  of 
War  Risk  Insurance,  but  only  when  the  return  of  the  body  to  the 
former  home  of  the  deceased  is  requested  by  a  person  entitled  to  the 
custody  of  the  body  for  the  purposes  of  interment.     The  amount 
so  payable  shall  include  the  usual  charges  for  transportation  of  the 
body  and  any  additional  expense  that  may  be  incurred  in  order  to 
conform  to  the  regulations  of  the  carrier  and  the  health  laws  of  the 
State  where  death  occurred  or  of  the  States  through  which  the  body 
will  pass,  in  respect  to  the  preparation  of  the  body  for  transportation 
and  the  character  of  the  container  of  the  body.     If  under  the  regula- 
tions of  the  carrier  or  under  the  health  laws,  an  attendant  must  ac- 
company the  body,  the  necessary  and  reasonable  expenses  of  such  at- 
tendant, in  going  to  and  returning  from  the  former  home  of  the  de- 
ceased, may  be  included. 

320.  When  friends  or  relatives  claim  the  body  and  assume  charge 
of  the  funeral  arrangements  of  a  deceased  patient  not  a  beneficiary 
of  the  Bureau  of  the  War  Risk  Insurance,  no  part  of  the  expenses  of 
the  same  will  be  paid  by  the  Public  Health  Service. 


48 

321.  Moneys  and  valuable  effects  of  deceased  seamen  remaining 
unclaimed  for  three  months  after  endeavor  has  been  made  to  comply 
with  the  provisions  of  paragraph  316  shall  at  the  close  of  each  quarter 
be  delivered  by  the  medical  officer  of  the  service  to  the  proper  cus- 
toms officer. 

322.  The   customs   officer  will   sign  triplicate   receipts   for  such 
moneys  and  effects  deposited  by  officers  of  the  service,  and  will  for- 
ward the  original  to  the  Secretary  of  the  Treasury ;  the  duplicate  and 
triplicate  will  be  forwarded  to  medical  officer  in  charge  of  the  hos- 
pital concerned,  who  will  transmit  the  duplicate  to  the  Surgeon 
General,  and  retain  the  triplicate  as  his  personal  voucher.    In  for- 
warding the  duplicate,  the  medical  officer  in  charge  will  accompany  it 
with  a  letter  of  transmittal,  accompanied  by  a  descriptive  list  of  the 
deceased.    Customs  officers  will  deposit  money  so  received  to  the  credit 
of  the  Secretary  of  the  Treasury,  Special  Deposit  Account  No.  3. 

323.  The  valuable  effects  of  deceased  seamen  deposited  with  the 
customs  officer,  as  provided  in  paragraph  321,  which  shall  remain  un- 
claimed for  a  period  of  one  year,  shall  be  sold  at  public  auction  by 
the  customs  officer  when  authority  has  been  obtained  from  the  Secre- 
tary of  the  Treasury,  and  the  receipts  accruing  from  such  sale  shall 
be  deposited  by  the  customs  officer  as  provided  in  the  preceding 
paragraph. 

324.  At  third  and  fourth  class  stations  the  customs  officer  (or  act- 
ing assistant  surgeon,  if  in  charge  of  the  station)  shall  at  the  end  of 
each  quarter  report  to  the  department  the  name  and  description  of 
any  and  all  patients  of  the  service  who  may  have  died  leaving  either 
money  or  valuables,  or  both,  in  their  custody  which  have  remained 
unclaimed  after  three  months. 

ARTICLE  VIII. 

TRANSPORTATION  OF  PATIENTS. 

325.  In  the  interest  of  economy  and  the  welfare  of  beneficiaries,  the 
Surgeon  General  is  authorized  to  order  the  transfer  of  patients  in 
the  care  of  necessary  attendants  from  one  station  to  another  and  to 
all  hospitals  for  the  insane,  together  with  expenses  incident  to  the 
transfer  of  both  patients  and  attendants. 

326.  Great  discretion  must  be  exercised  in  authorizing  travel  on 
Government  requests  for  transportation.    Officers  who  have  been  em- 
powered by  the  Surgeon  General  to  grant  this  privilege  in  connection 
with  the  treatment  of  beneficiaries  of  the  Public  Health  Service  shall 
investigate  with  particular  care  each  case  before  a  decision  is  reached 
to  allow  transportation  at  the  expense  of  the  Government. 

327.  The  issuance  of  transportation  requests  shall  be  under  the  im- 
metliate  supervision  of  the  officer  signing  these  requests,  and  he  shall 


49 

consider  himself  personally  responsible  for  the  justification  of  every 
request  issued. 

328.  In  order  to  be  valid,  transportation  requests  must  be  counter- 
signed by  the  issuing  officer.    Unused  transportation  requests  must 
be  carefully  preserved  under  lock  and  key,  and  any  loss  immediately 
reported  to  the  Surgeon  General.    The  names  and  designation  of  the 
additional  persons  not  given  on  the  face   of   the   request   shall   bo 
written  in  full  on  the  back  of  the  transportation  requests  (as,  John 
Doe,  patient;  James  Smith,  attendant).     It  is  very  important  that 
this  be  done  in  order  that  the  accounts  may  be  properly  audited. 

329.  The  travel  expenses  of  a  patient  of  the  Bureau  of  War  Risk 
Insurance  to  the  place  of  examination,  and  his  expense  in  returning 
to  his  home  are  payable  by  the  Bureau  of  War  Risk  Insurance. 

330.  The  travel  expenses  of  a  patient  of  the  Bureau  of  War  Risk 
Insurance  from  one  hospital  to  another,  after  he  begins  to  receive 
treatment  is  chargeable  to  the  Public  Health  Service. 

331.  Travel  expense  for  patients  leaving  service  hospitals  contrary 
to  advice  or  who  are  discharged  for  insubordination  will  not  be  paid 
by  the  Public  Health  Service. 

332.  When   persons   suffering   from    psychopathic    disorders   are 
transferred  from  one  hospital  to  another,  a  sufficient  number  of 
nurses  or  attendants  must  be  supplied  to  conduct  them  safely.    Such 
attendants  should  be  familiar  with  the  care  of  psychopathic  cases  and 
provided  with  appropriate  equipment  and  transportation  facilities, 
in  order  humanely  to  surround  the  patients  with  the  necessary  safe- 
guards.    When  three  or  more  patients  are  transferred  at  any  one 
time,  a  medical  officer  shall  accompany  them. 

333.  When  a  mentally  disordered  female  patient  of  the  service  is 
being  transferred,  she  must  always  be  accompanied  by  a  female 
nurse,  specially  trained  in  the  care  and  management  of  psychopathic 
disorders. 

334.  Officers  and  others,  when  furnishing  transportation  to  bene- 
ficiaries, shall  inform  the  receiving  officer  in  advance  by  mail  or  tele- 
graph when  the  patients  may  be  expected  to  arrive  and  whether  an 
ambulance  will  be  required. 

ARTICLE  IX. 
INSPECTION  OF  BELIEF  STATIONS. 

335.  All  relief  stations  of  the  service  shall  be  inspected  at  least 
once  a  year  by  one  of  the  commissioned  officers  detailed  by  the  Sur- 
geon General  to  the  Inspection  Service.    Officers  in  charge  of  stations 
shall  be  prepared  to  submit  to  the  inspecting  officer,  at  any  time,  all 
information  and  data  mentioned  in  the  Synopsis  for  the  Instruction 
of  Inspectors  of  the  Public  Health  Service. 

185279°— 20 4 


50 

336.  Inspection  of  stations  of  the  first,  second,  and  third  class  will 
be  made  wherever  practicable  by  a  senior  officer,  but,  as  occasion 
may  require,  any  officer  regularly  detailed  by  the  Surgeon  General 
as  a  general  inspector  has  authority,  when  so  detailed,  without  re- 
spect to  seniority,  to  inspect  any  station. 

337.  Inspections  shall  be  made  under  special  orders  defining  their 
object,  which  Avill  be  shown  to  medical  officers  in  charge  whose  sta- 
tions are  to  be  inspected;  and  such  medical  officer  in  charge  and 
others  on  duty  at  that  station  are  required  to  afford  every  facility 
and  assistance  to  the  inspecting  officer  during  his  inspection. 

338.  Officers  detailed  to  inspect  relief  stations  of  the  first  class 
shall  conduct  inspections  in  the  uniform  prescribed,  and  in  accord- 
ance with  the  Synopsis  for  the  Instruction  of  Inspectors  of  the 
Public  Health  Service.    The  inspecting  officer  shall,  accompanied  by 
the  medical  officer  in  charge,  personally  visit  every  part  of  the  sta- 
tion, and  shall  make  such  notes  during  this  tour  as  may  be  necessary 
to  enable  him  to  prepare  a  report,  in  accordance  with  regulations. 
Upon  completion  of  the  inspection,  the  inspecting  officer  shall  note  in 
the  journal  of  the  station  the  fact  of  such  inspection,  signing  such 
entry  with  official  title. 

339.  The  methods  of  procedure  during  a  general  inspection  shall 
be  under  the  direction  of  the  inspecting  officer,  and  he  shall  have 
authority  to  require  the  assistance  of  all  officers  and  others  on  duty  at 
the  station  to  furnish  information,  and  to  require  the  production  of 
all  books  and  other  records  of  the  station. 

340.  Inspecting  officers  shall  inform  themselves  fully  as  to  the  con- 
duct of  the  service  and  the  observance  of  the  regulations  at  each  sta- 
tion inspected,  and  shall  carefully  examine  the  books,  reports,  register 
of  patients,  clinical  records,  files,  correspondence,  money  accounts, 
cash  on  hand,  local  hospitals  under  contract,  and  the  buildings  and 
property  for  which  the  medical  officer  in  charge  is  responsible. 

341.  The  inspecting  officer  shall  not  give  orders  unless  specifically 
authorized  to  do  so.    It  shall  be  the  duty  of  the  inspecting  officer, 
however,  to  call  the  attention  of  the  medical  officer  in  charge  to  any 
infraction  of  the  service  regulations  or  to  the  existence  of  any  condi- 
tion which  may  be  contrary  to  the  best  interests  of  the  service. 

342.  Before  his  departure  from  the  station  the  inspecting  officer 
should  deliver  in  writing  to  the  medical  officer  in  charge  such  recom- 
mendations as  he  may  deem  advisable.     If  this  is  impracticable 
before  departure  from  the  station,  recommendations  may  be  for- 
warded from  the  next  station  visited  by  the  inspecting  officer.    These 
should  embody  such  subjects  as  seem  to  demand  immediate  attention, 
and  as  authority  for  their  execution  the  medical  officer  in  charge 
shall  cite  the  report  of  the  inspecting  officer  with  the  date  of  in- 
spection. 


51 

343.  Should  the  medical  officer  in  charge  radically  disagree  with 
any  of  the  recommendations  offered,  the  inspecting  officer  will  note 
such  difference  of  opinion  in  his  report,  and  the  execution  of  those 
particular  recommendations  shall  await  the  approval  of  the  Surgeon 
General. 

344.  Reports  of  inspecting  officers  shall  be  rendered  in  accordance 
with  the  directions  contained  in  the  Synopsis  for  the  Instruction  of 
Inspectors  of  the  Public  Health  Service,  and  no  detail  shall  be 
omitted,  excepting  where  clearly  inapplicable  to  the  station  under 
inspection,  but  in  such  cases  this  fact  will  be  stated.     The  data  in 
the  report  shall  be  paragraphed  and  headed  by  the  name  and  num- 
ber to  which  it  corresponds  in  the  Synopsis  for  the  Instruction  of 
Inspectors  of  the  Public  Health  Service.     Whenever  information 
is  furnished  upon  a  subject  Avhich  does  not  appear  in  the  synopsis 
it  shall  be  included  under  "Remarks"  or  appended  to  the  report 
under  an  appropriate  heading. 

345.  The  reports  of  inspecting  officers  shall  be  made  separately  for 
each  station  and  in  quadruplicate  and  forwarded  to  the  Chief  of  In- 
spection Service  who  will  review  and  submit  to  the  Surgeon  General 
as  soon  as  practicable  after  the  completion  of  the  inspection. 

346.  Whenever,  in  the  opinion  of  the  inspecting,  officer,  immediate 
action  is  imperative  and  additional  authority  is  required,  his  recom- 
mendations may  be  forwarded  by  telegraphic  night  letter,  or  in  such 
other  manner  as  the  exigencies  of  the  case  demand. 

347.  Reports  of  inspecting  officers  will  be  considered  confidential, 
and  under  no  circumstances  will  copies  be  furnished  to  the  medical 
officer  in  charge  of  the  station  inspected  except  when  specifically 
authorized  by  the  Surgeon  General.  , 

348.  Inspecting  officers  shall  report  at  once  to  the  medical  officer  in 
charge  any  conditions  which   require  immediate  correction.     Full 
reports  of  same,  whether  corrected  during  the  visit  of  the  inspecting 
officer  or  not,  shall  be  forwarded  to  the  Surgeon  General  in  the 
report  of  the  inspection  of  the  station. 

349.  The  inspecting  officer  shall  personally  examine  the  financial 
accounts  of  the  officer  in  charge,  and  of  any  subordinate  accountable 
officers  at  the  station,  and  for  this  purpose  the  inspecting  officers 
shall  be  supplied  with  all  the  information  available  and  such  clerical 
assistance  as  may  be  required. 

350.  The  inspecting  officer  shall  examine  such  unserviceable  prop- 
erty as  may  be  presented  by  the  officer  in  charge,  and,  in  order  to 
facilitate  such  examination  an  inventory  containing  a  full  descrip- 
tion of  such  property  shall  be  always  in  readiness.     When,  in  the 
opinion  of  the  inspecting  .officer,  property  presented  for  condemna- 
tion is  capable  of  repair  and  further  use,  he  shall  so  state  upon  the 


52 

inventory,  and  the  officer  in  charge  shall  take  steps  at  once  to  reclaim 
such  property. 

351.  The  inspecting  officer  shall  personally  examine  all  requisitions 
rendered  since  the  last  inspection,  and  any  that  may  be  pending  or 
contemplated,  and  he  shall  express  his  opinion  in  the  report  as  to 
whether  or  not  due  economy  has  been  practiced  in  the  use  of  sup- 
plies and  whether  or  not  the  items  on  contemplated  requisitions  are 
actually  needed. 

352.  Pie  will  make  a  thorough  inspection  of  the  supplies  on  hand 
in  the  warerooms  and  prepare  a  list  of  supplies  which,  in  his  opin- 
ion, are  in  excess  of  the  needs  of  the  station.    He  will  forward  this 
list  to  the  Surgeon  General  with  his  report. 

353.  Upon  the  arrival  of  an  inspecting  officer,  medical  officers  in 
charge  will  cause  to  be  conspicuously  published  the  fact  of  the 
visit,  with  the  information  that  any  officer  or  employee  on  duty  at 
the  station  shall  be  afforded  an  opportunity  to  meet  the  inspecting 
officer  for  the  purpose  of  making  any  justifiable  complaint. 

354.  The  inspecting  officer  shall,  particularly  inquire  into  the  firt 
hazards,  both  within  and  adjacent  to  a  station;  he  shall  also  care- 
fully note  the  location  and  condition  of  all  fire-prevention  apparatus. 
At  each  station  there  should  be  conspicuously  published  complete  fire 
regulations,  and  every  officer,  employee,  and  patient  shall  be  as- 
signed in  such  regulations  to  a  definite  post  or  exit  in  case  of  fire. 
The  inspecting  officer  will  satisfy  himself  that  this  requirement  is 
fully  met. 

355.  The  inspecting  officer  shall  cause  to  be  tested  in  his  presence 
any  fire-protection  apparatus  which,  in  his  opinion,  may  require 
such  scrutiny.     Fire  axes,  crowbars,  and  other  implements  of  like 
character  must  not  be  kept  in  wards  or  corridors.     The  inspecting 
officer  will  call  to  the  attention  of  the  medical  officer  in  charge  any 
infraction  of  this  rule  in  order  that  the  location  of  such  implements 
may  be  changed  to  place  them  out  of  reach  of  the  patients. 

• 

INSPECTIONS  BY  MEDICAL  OFFICERS  IN  CHARGE. 

356.  Once  a  week  the  medical  officers  in  charge  of  hospitals  shall 
make  a  thorough  inspection  of  the  buildings  and  grounds  of  the 
station.     All    wards,   quarters,   operating   rooms,    dressing    rooms, 
laboratories,   offices,   warehouses,   shops,  garages,   kitchens,   dining 
rooms,  etc.,  shall  be  inspected  in  detail. 

357.  As  the  weekly  inspection  is  an  important  duty  devolving  upon 
the  medical  officer  in  charge,  it  is  not  expected  that  he  will  delegate 
its  performance  to  a  junior  officer,  except  in  cases  of  urgent  necessity 
requiring  his  absence. 


53 

358.  The  weekly  inspection  of  the  medical  officer  in  charge  shall  be 
held  on  Saturday,  and  he  should  be  accompanied  by  the  following 
persons  during  his  inspection : 

(1)  By  the  officers  in  charge  of  medical  and  surgical  services 
while  inspecting  wards,  operating  rooms,  and  dressing  rooms. 

(2)  By  the  chief  nurse  while  inspecting  wards,  operating  rooms, 
dressing  rooms,  and  the  nurses'  quarters. 

(3)  By  the  chief  dietitian   while  inspecting  subsistence   store- 
rooms, kitchens,  and  dining  room. 

(4)  By  the  materiel  officer  throughout  the  entire  inspection. 

359.  Informal  unannounced  inspections  of  the  various  buildings, 
wards,  and  departments  of  station  shall  be  made  by  medical  officers 
in  charge  at  frequent  intervals  and  at  any  time  during  the  24  hours. 
Medical  officers  in  charge  should  devote  a  portion  of  each  day  to 
this  purpose. 

ARTICLE  X. 

BENEFICIARIES. 

360.  The  following  persons  are  entitled  to  the  benefits  and  facilities 
of  the  hospitals  and  relief  stations  of  the  service  under  special  rules 
hereinafter  prescribed. 

(1)  Those  employed  on  board  in  the  care,  preservation,  or  naviga- 

tion of  any  registered,  enrolled,  or  licensed  vessels  of  the 
United  States,  or  in  the  service  on  board  of  those  engaged  in 
such  care,  preservation,  or  navigation. 

(2)  Seamen  employed  on  yachts,  provided  the  said  yachts  are  en- 

rolled, licensed,  or  registered  as  vessels  of  the  United  States. 

(3)  Seamen  employed  on  United  States  Army  transports  or  other 

vessels  belonging  to  the  United  States  Army,  when  not  en- 
listed men  of  the  Army. 

(4)  Officers  and  enlisted  men  of  the  United  States  Coast  Guard. 

(5)  Officers  and  employees  of  the  Public  Health  Service. 

"  (6)   Seamen  employed  on  the  vessels  of  the  Mississippi  River  Com- 
mission. 

(7)  Seamen  employed  on  the  vessels  of  the  Engineer  Corps  of  the 

Army. 

(8)  Officers,  crews  of  vessels,  keepers,  and  assistant  keepers  of  the 

Lighthouse  Service. 

(9)  Officers  and  seamen  on  vessels  of  the  Coast  and  Geodetic  Sur- 

vey. 

(10)  Civil  employees  of  the  United  States  who  are  injured  while 

in  the  performance  of  their  duties. 

(11)  Officers  and  crews  of  vessels  of  the  Bureau  of  Fisheries. 

(12)  Patients  of  the  Bureau  of  War  Risk  Insurance. 

(13)  Patients  for  special  study  and  investigation. 


54 


361.  No  person  employed  in  or  connected  with  the  navigation, 
management,  or  use  of  canal  boats  engaged  in  the  coasting  trade  shall, 
by  reason  thereof,  be  entitled  to  any  benefit  or  relief  from  the  service. 

362.  In  case  of  doubt  as  to  the  fact  of  registration,  enrollment,  or 
license  of  a  vessel,  the  officer  to  whom  application  for  relief  is  made 
shall  request  information  of  the  collector  of  customs  at  the  port  as  to 
the  character  of  vessel  on  which  the  seaman  is  employed,  and  the 
said  collector  of  customs  shall  furnish  Such  information,  if  practi- 
cable. 

363.  Seamen  taken  from  wrecked  vessels  of  the  United  States  are 
entitled  to  the  benefits  of  the  service  if  sick  or  disabled,  and  will  be 
furnished  care  and  treatment  without  reference  to  the  length  of  time 
they  have  been  emploj^ed. 

364.  Seamen  employed  on  merchant  vessels  of  the  United  States 
returned  to  the  United  States  from  foreign  ports  by  United  States 
consular  officers,  if  sick  or  disabled  at  the  time  of  their  arrival  in  a 
port  of  the  United  States,  shall  be  entitled  to  the  benefits  of  the  serv- 
ice without  reference  to  length  of  service. 

365.  A  sick  or  disabled  seaman,  in  order  to  obtain  the  benefits  of 
the  service,  must  apply  in  person,  or  by  proxy  if  too  «ick  or  disabled 
so  to  do,  at  the  office  of  the  Public  Health  Service,  to  an  officer  of  that 
service,  or  to  the  proper  customs  officer  acting  as  the  agent  of  the 
said  service  at  stations  where  no  medical  officer  is  on  duty,  and  must 
furnish  satisfactory  evidence  that  he  is  entitled  to  relief  under  the 
regulations. 

366.  Masters'  certificates  and  discharges  from  United  States  ship- 
ping commissioners,  made  out  and  signed  in  proper  form,  shoAving 
that  the  applicant  for  relief  has  been  employed  for  60  days  of  continu- 
ous service  "  in  a  registered,  enrolled,  or  licensed  vessel  of  the  United 
States,"  a  part  of  which  time  must  have  been  during  the  60  days  im- 
mediately preceding  his  application  for  relief,  shall  entitle  him  to 
treatment.     The  phrase  "  60  days  continuous  service  "  shall  not  bo 
held  to  exclude  seamen  whose  papers  show  brief  intermission  between 
short  services  that  aggregate  the  required  60  days,  provided  that  such 
intermission  does  not  exceed  60  days. 

367.  The  certificate  of  the  owner  or  accredited  commercial  agent  of 
a  vessel  as  to  the  facts  of  the  employment  of  any  seaman  on  said  ves- 
sel may  be  accepted  as  evidence  in  lieu  of  the  master's  certificate  in 
cases  where  the  latter  is  not  procurable. 

368.  Masters  of  documented  vessels  of  the  United  States  shall,  on 
demand,  furnish  any  seaman  who  has  been  employed  on  such  vessel 
a  certificate  of  the  length  of  time  said  seaman  has  been  so  employed, 
giving  the  dates  of  such  employment.     This  certificate  will  be  filed 
in  the  Public  Health  Service  or  marine  hospital  office  or  office  of  the 


55 

customs  officer  when  application  is  made  for  relief  if  relief  is  fur- 
nished. 

369.  When  an  applicant's  claim  for  relief  is  rejected,  a  copy  or 
copies  of  the  master's  certificate  or  other  papers  in  the  case  must 
be  made,  and  the  cause  or  causes  for  such  rejection  indorsed  on  said 
copy  or  copies,  which  shall  then  be  placed  on  file  at  the  station. 

370.  Any  master  of  a  vessel  or  other  person  who  shall  furnish  a 
false  certificate  of  service  Avith  intent  to  procure  the  admission  of  a 
seaman  into  any  marine  hospital  shall  be  immediately  reported  to  the 
nearest  United  States  district  attorney  for  prosecution. 

371.  When  an  interval  has  occurred  in  the  applicant's  seafaring- 
service  by  reason  of  the  closure  of  navigation,  such  interval  shall 
not  be  considered  as  excluding  him  from  relief. 

372.  During  the  season  when  navigation  is  closed  at  any  port,  sea- 
men applying  for  relief  at  such  ports  shall  be  entitled  to  same,  pro- 
vided they   present  the  documentary   evidence   in   paragraph  366, 
which  must  show  that  the  applicants  were  employed  within  60  days 
immediately  preceding  the  said  closure  of  navigation. 

373.  The  time  during  which  a  seaman  has  been  under  treatment  in 
hospital  as  a  patient  of  the  service  shall  not  be  reckoned  as  absence 
from  vessel  in  respect  to  debarring  him  from  further  relief. 

374.  Whenever  an  applicant  for  relief  presents  himself  at  a*  Public 
Health  Service  or  marine  hospital  office  or  at  a  customhouse  without 
a  master's  certificate  or  shipping  commissioner's  discharge,  and  it  is 
impracticable  to  obtain  such  certificate,  the  affirmation  of  the  ap- 
plicant as  to  the  facts  of  his  last  employment,  stating  names  of  ves- 
sels and  dates  of  service,  may  be  accepted  as  evidence  in  support  of 
his  claim  for  the  benefits  of  the  service. 

375.  When  the  period  of  the  seaman's  service  as  shown  by  his  cer- 
tificate on  last  vessel  is  less  than  60  days,  his  affirmation  as  to  pre- 
vious service  may  be  accepted. 

376.  In  cases  of  doubt,  reasonable  effort  shall  be  made  to  verify 
the  genuineness  of  masters'  certificates  and  shipping  commissioner's 
discharges,  and  of  the  signature  to  the  same.     Due  care  shall  also  be 
exercised  to  identify  the  persons  presenting  masters'  certificates. 

377.  When  a  reasonable  doubt  exists  \vhether  the  applicant  is  en- 
titled to  relief  under  the  regulations,  the  application,  accompanied 
by  a  statement  of  the  facts,  shall  be  immediately  referred  to  the  Sur- 
geon General  for  decision,  and  when  the  seaman  is  in  such  condition 
that  immediate  medical  or  surgical  attendance  is  necessary,  he  will 
be  placed  under  treatment  pending  the  decision  and  the  action  in  the 
case  by  the  officer  shall  be  reported. 

378.  When  a  seaman  applies  for  relief  after  an  absence  of  60  clays 
or  more  from  his  last  vessel  and  it  satisfactorily  appears  that  it  was 


56 

impracticable  for  him  to  apply  to  the  proper  officer  for  treatment 
or  that  he  obtained  treatment  at  his  own  expense,  a  statement  of  the 
facts,  together  with  a  copy  of  the  application  and  other  papers  in 
support  of  same,  shall  be  filed  and  the  seaman  admitted  to  hospital. 

379.  Any  seaman  who  is  able  to  write  will  be  expected  to  sign  his 
name  upon  the  face  of  the  master's  certificate  issued  to  him  before 
said  certificate  is  signed  by  the  master  of  the  vessel,  and  the  officer 
receiving  such  certificate  shall  require  the  applicant  to  verify  the 
signature  in  his  presence. 

380.  When  patients  are  admitted  for  hospital  treatment  pending 
the  decision  of  the  Surgeon  General,  the  usual  report  on  Form  1971-F 
shall  be  forwarded  to  the  district  supervisor,  and  the  authority  re- 
corded on  the  patient's  record  card  as  soon  as  it  is  received.    If  relief 
is  not  authorized,  the  applicant  shall  be  discharged  and  the  disap- 
proval recorded  on  the  completed  report  card  and  on  the  record  card. 

381.  When  a  seaman  who  has  received  continuous  treatment  at  the 
out-patient  office  for  a  period  of  two  months  applies  for  further 
treatment  he  must,  to  entitle  him  to  treatment,  furnish  a  new  cer- 
tificate of  service  showing  that  he  is  still  following  his  vocation 
as  seaman,  or  give  satisfactory  evidence  that  such  service  has  been 
prevented  by  closure  of  navigation  or  by  sickness,  the  latest  dates 
of  serrice,  and,  in  case  of  lack  of  recent  servicej  its  explanation,  to 
appear  on  his  record  card. 

382.  The  expenses  of  caring  for  sick  and  disabled  seamen  incurred 
during  a  voyage  will  not  be  paid  by  the  service. 

383.  The  expenses  for  the  care  and  treatment  of  patients  suffering 
from  contagious  diseases,  who  are  entitled  to  the  benefits  of  the  serv- 
ice, and  who,  in  accordance  with  the  State  or  municipal  health  laws 
and  regulations  are  taken  to  quarantine  or  other  hospitals  under 
charge  of  the  local  health  authorities,  will  not  be  paid  unless  such 
patients  were  admitted  at  the  time  by  the  request  of  an  officer  of  the 
service. 

384.  In  no  case  shall  money  be  paid  to  a  seaman  or  to  his  family 
or  friends  by  the  service  as  reimbursement  for  expenses  incurred 
during  his  sickness  or  disability. 

385.  Seamen  who  may  be  injured  in  street  brawls  or  while  com- 
mitting a  breach  of  the  peace,  and  are,  therefore,  confined  in  jail  or 
taken  to  civil  hospitals  by  the  local  authorities  for  such  acts,  shall 
not  receive  treatment  at  the  expense  of  the  service.     Such  seamen 
should,  however,  be  furnished  treatment  if  brought  to  service  or  con- 
tract hospital. 

386.  Seamen  taken  sick  or  injured  on  board  or  ashore  while  actu- 
ally employed  on  a  documented  vessel  shall  be  entitled  to  treatment 
at  relief  stations  without  reference  to  the  length  of  their  service. 


57 

387.  A  certificate  of  discharge  may,  at  the  discretion  of  the  officer 
in  charge  of  the  case,  be  given  to  a  hospital  patient,  but  such  certifi- 
cate, when  presented  at  another  relief  station,  shall  not  be  taken  as 
sufficient  evidence  of  the   applicant's  title  to   hospital  relief,   but 
may  be  considered  as  collateral  to  other  satisfactory  data  submitted 
by  the  seaman. 

388.  Temporary  relief  only  is  contemplated,  and  admission  to  hos- 
pital is  not  intended  to  permit  an  indefinite  residence  therein  for 
cause  other  than  actual  disease  or  injury. 

389.  The  Surgeon  General  is  authorized  to  issue  orders  for  the 
temporary  care  and  treatment  of  sick  seamen  at  minor  stations  and 
for  the  transfer  of  patients,  including  necessary  expenses,  whenever 
the  interests  of  the  service  demand  such  transfers. 

THE   UNITED    STATES    COAST    GUARD. 

390.  Commissioned  officers  of  the  United  States  Coast  Guard  shall 
receive  the  same  hospital  and  out-patient  relief  as  provided  by  law 
for  commissioned  officers  in  the  Army. 

391.  Officers  of  the  United  States  Coast  Guard  on  leave,  on  sick 
leave,  or  retired  will  be  furnished  relief  by  the  Public  Health  Service 
at  Public  Health   Service  and  marine  hospitals  operated  by  the 
service  and  dispensaries  conducted  by  the  service,  provided  no  bills 
for  the  same  are  incurred.    Officers  on  leave,  retired,  or  on  waiting 
orders  may  sign  their  own  certificates. 

392.  The  noncommissioned  officers  and  enlisted  men' of  the  United 
States  Coast  Guard  will  receive  hospital  or  out-patient  treatment,  as 
hereinafter  provided,  on  certificate  signed  by  the  commanding  officer 
or  executive  officer  of  a  Coast  Guard  cutter,  without  regard  to  length 
of  service.    The  certificates  shall  contain  a  description  of  the  appli- 
cant for  relief.     Officers  on  leave  or  waiting  orders  may  sign  their 
own  certificate. 

"393.  Any  officer,  warrant  officer,  or  enlisted  man  on  active  duty 
whose  condition  absolutely  requires  hospital  treatment  will  be  ad- 
mitted to  hospitals  at  stations  of  the  first  class  and  to  all  hospitals 
under  contract  with  the  service.  At  places  where  no  specific  arrange- 
ments for  treatment  in  hospital  are  made  the  regulations  governing 
emergency  admissions  at  fourth-class  stations  will  be  enforced.  At 
places  Avhere  no  specific  arrangements  for  hospital  treatment  are 
made,  officers  in  the  United  States  Coast  Guard  may,  when 
absolutely  necessary,  in  case  of  injury  or  severe  illness,  procure 
treatment  in  hospital  for  officers,  warrant  officers,  and  enlisted  men 
on  active  duty,  and  shall  immediately  report  to  the  district  super- 
visor of  the  Public  Health  Service,  forwarding  as  a  part  of  this 


58 

report  the  statement  of  the  attending  physician  certifying  the  neces- 
sity for  immediate  treatment  and  the  probable  duration  of  treatment 
required.  Vouchers,  on  proper  forms,  duly  certified  by  said  com- 
manding officer  and  receipted  by  the  person  rendering  the  bill,  shall 
be  forwarded  to  the  district  supervisor  of  the  Public  Health  Service. 

394.  Enlisted  men  of  the  United  States  Coast  Guard  shall  be  en- 
titled to  medical  relief  for  a  period  of  60  -days  after  having  been 
discharged  from  said  service,  as  is  granted  to  seamen  of  the  merchant 
marine.    The  presentation  of  a  certificate  of  honorable  or  ordinary 
discharge  and  satisfactory  identification  of  the  applicant  shall  be 
considered  sufficient  authority  for  such  medical  relief. 

395.  Officers  and  enlisted  men  or  surfmen  of  the  United  States 
Coast  Guard  shall  be  admitted  to  hospital  only  in  cases  where  the 
gravity  of  the  disease  or  injury  from  which  they  suffer  is  such  as  to 
require  hospital  treatment,  in  the  opinion  of  an  officer  of  the  Public 
Health  Service,  or  of  a  reputable  physician  designated  by  the  depart- 
ment to  act  at  a  place  where  no  officer  is  stationed,  or  one  temporarily 
employed,  as  provided  for  in  paragraph  393. 

396.  Patients  shall  be  promptly  discharged  upon  the  termination 
of  the  necessary  hospital  treatment,  but,  at  stations  of  first  class,  pa- 
tients may  be  held  pending  the  return  of  their  vessel. 

397.  Out-patient  treatment  will  be  furnished  at  all  stations  where 
an  officer  of  the  Public  Health  Service  is  on  duty.    At  all  other  sta- 
tions out-patient  relief  will  be  granted  only  in  cases  of  emergency  and 
under  the  provisions  of  the  regulations  relative  to  fourth-class  (emer- 
gency) stations.    When  absolutely  necessary  in  case  of  serious  injury 
or  illness,  the  temporary  attendance  of  a  physician  may  be  procured 
by  the  commanding  officer  of  a  Coast  Guard  vessel,  who  shall  immedi- 
ately report  his  action  to  the  district  supervisor,  forwarding  as  part 
o$  this  report  the  statement  of  the  attending  physician  certifying 
the  necessity  for  immediate  treatment  required.    Vouchers  on  proper 
forms,  duly  certified  by  said  commanding  officer  and  receipted  by  the 
person  rendering  the  bill,  shall  be  forwarded  to  the  district  super- 
visor. 

398.  At  ports  where  there  is  a  station  of  the  first  class,  when  an 
officer  or  member  of  a  crew  of  the  United  States  Coast  Guard,  on 
account  of  injury  or  illness,  requires  the  immediate  attention  of  a 
physician,  and  on  account  of  the  exigency  of  the  case  it  is  impossible 
to  convey  the  patient  to  the  hospital  or  out-patient  office,  temporary 
provision  for  medical  attendance  or  care  may  be  made  by  the  com- 
manding officer,  who  Avill  immediately  report  his  action  to  the  proper 
Public  Health  Service  or  marine  hospital  representative  at  the  port 
and  the  treatment  thereafter  will  be  conducted  by  the  Public  Health 
Service  if  in  the  judgment  of  the  proper  officer  of  the  Public  Health 
Service  it  can  be  done  without  detriment  to  the  patient. 


59 

399.  The  bills  for  the  emergency  treatment  will  be  forwarded  to 
the  Surgeon  General  through  said  officer  for  approval  and  payment. 
Unreasonable  charges  for  relief  furnished  in  emergency  cases  will 
not  be  allowed  by  the  department. 

400.  Commissioned  medical  officers  and  acting  assistant  surgeons 
of  the  Public  Health  Service  will  render  professional  aid  to  officers 
of  the  United  States  Coast  Guard  residing  at  the  port,  at  their  resi- 
dences, when  said  officers  of  the  United  States  Coast  Guard  for  any 
reason  can  not  avail  themselves  of  the  accommodations  offered  by 
marine  or  Public  Health  Service  hospitals,  and  when  they  are  physi- 
cally unable  to  present  themselves  at  a  hospital  office.     The  medi- 
cines or  appliances  prescribed  shall  be' furnished  from  the  dispensary 
of  the  Public  Health  Service  when  practicable. 

401.  Station  conveyances  may  be  used  to  convey  officers  engaged  in 
treating  Coast  Guard  officers  at  places  other  than  the  hospital  sta- 
tion, and  when  such  conveyances  are  not  available  the  officer  will  be 
allowed  necessary  traveling  expenses. 

OFFICERS  AND  EMPLOYEES  OF  THE  PUBLIC  HEALTH  SERVICE. 

402.  Commissioned  officers  and  pharmacists,  and  those  employees 
of  the  service  devoting  all  their  time  to  field  work,  when  taken  sick  . 
or  injured  in  line  of  duty,  may  be  given  necessary  relief  at  first, 
second,  and  third  class  relief  stations  of  the  service.    When  they  are 
physically  unable  to  present  themselves  at  such  hospitals  they  shall 
be  entitled  to  treatment  in  their  homes  by  commissioned  officers  or 
acting  assistant  surgeons  of  the  service.    The  medicines  and  appli- 
ances prescribed  shall  be  furnished  from  the  dispensary  of  the  Public 
Health  Service  when  practicable. 

THE    MISSISSIPPI   RIVER   COMMISSION. 

403.  Masters,  officers,  and  crews  of  vessels  in  the  service  of  the 
Mississippi  River  Commission  shall  be  entitled  to  the  benefits  of  the 
service  under  the  same  regulations  as  govern  the  admission  of  seamen 
on  documented  vessels.    No  charge  shall  be  made  for  their  care  and 
treatment. 

THE  ENGINEER  CORPS,  UNITED  STATES  ARMY. 

404.  Seamen  employed  on  vessels  under  the  charge  of  the  Engineer 
Corps  of  the  United  States  Army  shall  be  admitted  to  the  benefits 
of  the  service  without  charge  at  stations  of  the  first,  second,  third, 
and  fourth  class  upon  the  written  request  of  the  commanding  officer 
of  said  vessels. 


60 

THE   LIGHTHOUSE   SERVICE. 

405.  Officers  and  crews  of  the  several  vessels  belonging  to  the 
Lighthouse  Service,  including  lightships,  may  be  admitted  to  the 
benefits  of  the  Public  Health  Service  upon  the  application  of  their 
respective  commanding  officers.     No  charge  will  be  made  for  care 
and  treatment. 

406.  Light  keepers  and  assistant  light  keepers  of  the  Lighthouse 
Service  are  entitled  to  medical  relief  without  charge  at  hospitals  and 
other  stations  of  the  Public  Health  Service  under  the  rules  and  regu- 
lations governing  the  care  of  seamen  of  the  merchant  marine,  pro- 
vided that  such  keepers  and  assistant  keepers,  who  receive  an  original 
appointment  after  August  28,  1916,  pass  a  physical  examination  in 
accordance  with  rules  approved  by  the  Secretary  of  Commerce  and 
the  Secretary  of  the  Treasury. 

THE  COAST  AND  GEODETIC  SURVEY. 

407.  Officers  and  seamen  on  vessels  of  the  Coast  and  Geodetic  Sur- 
vey shall  be  entitled  to  relief  under  the  same  regulations  governing 
the  treatment  of  seamen  on  documented  vessels  except  as  hereinafter 
provided. 

When  immediate '  medical  aid  is  considered  absolutely  essential 
for  any  member  of  the  crew  of  a  vessel  of  the  Coast  and  Geo- 
detic Survey,  and  the  services  of  the  Public  Health  Service  can  not 
be  procured,  the  commanding  officer  of  the  vessel  may,  for  the  time 
being,  until  the  services  of  the  Public  Health  Service  can  be  obtained, 
avail  himself  of  the  most  suitable  local  facilities,  provided  the 
charges  are  reasonable,  and  shall  immediately  report  his  action  to 
the  district  supervisor,  forwarding  as  a  part  of  the  report,  the  state- 
ment of  the  attending  physician,  certifying  the  necessity  for  imme- 
diate treatment  and  the  probable  duration  of  same.  Vouchers  cov- 
ering the  expense  of  such  service  and  the  necessary  medicines,  prop- 
erly certified  and  accompanied  by  a  full  statement  of  the  circum- 
stances, shall  be  forwarded  to  the  district  supervisor.  This  para- 
graph shall  not  be  construed  to  authorize  relief  at  the  expense  of  the 
Public  Health  Service  in  foreign  ports  or  in  ports  of  the  Philippine 
Islands. 

BUREAU  OF  FISHERIES. 

408.  Officers  and  crews  of  the  several  vessels  belonging  to  the 
Bureau  of  Fisheries  may  be  admitted  to  the  benefits  of  the  Public 
Health  Service  without  charge,  upon  the  application  of  their  respec- 
tive commanding  officers. 


61 

INJURED  CIVIL  EMPLOYEES  OF  THE  UNITED  STATES  BENEFICIARIES  OF  THE 
FEDERAL   EMPLOYEES'    COMPENSATION    ACT. 

409.  Civil  employees  of  the  United  States,  who  are  injured  while 
in  the  performance  of  their  duties,  shall  be  furnished,  upon  applica- 
tion and  without  personal  charge,  needed  medical  and  surgical  treat- 
ment by  medical  officers  at  first,  second,  and  third  class  relief  sta- 
tions of  the  service,  provided  the  applicant  shall  present  to  the  medi- 
cal officer  a  "  Request  for  treatment "  on  the  United  States  Em- 
ployees' Compensation  Commission's  Form  CA-16,  or  a  letter  re- 
citing that  the  bearer (giving  the  name)  is  an  employee  of 

the  United  States,  employed  at  (giving  the  name  of  the 

office  or  establishment)   that  he  was  injured  in  the  performance 

of   duty  on  (giving  the   date   and   nature   of  the   injury) 

and  that  treatment  is  requested  for  the  results  of  said  injury  under 
section  9  of  the  compensation  act,  the  forms  or  letter  to  be  signed 
by  the  applicant's  official  superior. 

410.  Section  9,  United  States  Employees'  Compensation  act : 

That  immediately  after  an  injury  sustained  by  an  employee  while  in  the 
performance  of  his  duty,  whether  or  not  disability  has  arisen,  and  for  a  reason- 
able time  thereafter,  the  United  States  shall  furnish  to  such  employee  reason- 
able medical,  surgical,  and  hospital  services  and  supplies  unless  he  refuses  to 
accept  them.  Such  services  and  supplies  shall  be  furnished  by  United  States 
medical  officers  and  hospitals,  buf  where  this  is  not  practicable  shall  be  fur- 
nished by  private  physicians  and  hospitals  designated  or  approved  by  the  com- 
mission and  paid  for  from  the  employees'  compensation  fund.  If  necessary 
for  the  securing  of  proper  medical,  surgical,  and  hospital  treatment,  the  em- 
ployee, in  the  discretion  of  the  commission,  may  be  furnished  transportation  at 
the  expense  of  the  employees'  compensation  fund. 

411.  Beneficiaries  of  the  compensation  act  will  also  be  admitted 
for  examination  or  treatment  upon  the  request  of  the  United  States 
Employees'  Compensation  Commission. 

412.  In  case  it  has  been  impracticable  for  an  employee  to  obtain  a 
"  Request  for  treatment "  the  medical  officer  may  furnish  temporary 
treatment  upon  the  statement  of  the  injured  employee  giving  the 
facts,  together  with  the  name  of  the  Government  establishment  in 
which  he  is  employed.     In  such  instances,  a  proper  ';  Request  for 
treatment "  will  be  obtained  within  48  hours  thereafter  from  the 
employee's  official  superior. 

413.  Cases  coming  under  the  compensation  act  are  morbid  condi- 
tions and  disabilities  resulting  from  the  nature  or  conditions  of  em- 
•ployment  at  the  place  of  employment.    These  include  all  so-called 
accidents  which  occur  at  places  of  employment  during  hours  of  em- 
ployment.   Tuberculosis,  pneumonia,  typhoid  fever,  and  malaria,  .as 
well  as  lead  poisoning  and  other  recognized  occupational  diseases 


62 

may  come  under  the  provisions  of  the  compensation  act  when  these 
ailments  are  a  result  of  the  conditions  or  nature  of  work. 

414.  At  United  States  marine  and  Public  Health  Service  hospitals 
no  charge  shall  be  made  for  services  or  supplies  furnished  injured 
civil  employees  of  the  United  States,  excepting  where  expenditures 
are  incurred  for  prosthetic  or  orthopedic  appliances,  orthpedic  boots, 
ambulance  hire,  X-ray  service,  or  similar  expenses. 

415.  At  second  and  third  class  relief  stations  of  the  service  ex- 
penditures incurred  on  account  of  either  office  or  hospital  treatment 
furnished  injured  civil  employees  of  the  United  States,  shall  be  taken 
up   on   the   Employees'   Compensation   Commission's   Form   D-19. 
When  this  is  not  available,  Public  Health  Service  Form  1926  or  1949 
may  be  used  and  should  be  headed  United  States  Employees'  Com- 
pensation Commission.     The  voucher  accompanied  by  the  original 
"  Request  for  treatment "  of  the  employee  will  be  forAvarded  to  the 
district  supervisor.     The  rates  charged  shall  be  the  contract  rates 
for  service  patients  at  said  stations.    Expenditures  incurred  at  first- 
class  stations  on  account  of  beneficiaries  of  the  compensation  act 
shall  be  handled  in  a  similar  manner. 

416.  Expenditures  payable  by  the  Employees'  Compensation  Com- 
mission shall  not  be  listed  among  expenditures  noted  on  Monthly 
Schedule  of  Encumbrances,  Form  1955,  nor  shall  they  be  taken  up 
on  Monthly  Report  of  Relief  Furnished  Foreign  Seamen  and  Other 
Pay  Patients,  Form  1927.    No  charge  shall  be  made  for  professional 
services  furnished  said  injured  civil  employees  by  medical  officers  of 
the  service,  nor  shall  any  be  made  for  supplies  in  stock  furnished 
such  persons.    Fees  for  examiners  and  others  not  on  a  salary  basis  are 
chargeable  to  the  Federal  Employees'  Compensation  Commission. 

417.  In  order  that  injured  employees  may  be  furnished  as  complete 
medical  and  surgical  service  as  possible,  the  Employees'  Compensation 
Commission  will  pay  the  necessary  car  fare  to  those  who  are  able  to 
return   to   the    dispensary   for   treatment.     The    injured    employee 
should  be  definitely  instructed  whether  and  when  he  is  to  return  for 
further  treatment. 

418.  In  cases  where  the  injury  requires  such  action  an  ambulance 
(one  owned  by  a  United  States  marine  or  Public  Health  Service 
hospital,  or  a  contract  hospital)  should  be  called  and  the  employee 
sent  to  a  United  States  marine  or  Public  Health  Service  hospital  or 
a  contract  hospital  at  once.    When  neither  a  United  States  marine 
or  Public  Health  Service  hospital  ambulance  nor  a  contract  hospital 
ambulance  is  available,  the  Employees'  Compensation  Commission 
will   allow   a   reasonable   charge   for  other  ambulance  or  carriage 
service,  but  in  all  such  cases  the  employee  should  be  sent  to  a  United 
States  marine  or  Public  Health  Service  hospital  or  contract  hospital, 
if  practicable. 


63 

419.  When  an  employee  of  the  United  States  has  lost  a  leg  or  part 
of  a  leg  as  a  result  of  an  injury  for  which  he  is  entitled  to  the  bene- 
fits of  the  compensation  act,  the  Employees'  Compensation  Com- 
mission will  furnish  a  temporary  artificial  leg  if,  and  for  the  time, 
a  temporary  leg  is  needed.    The  commission  will  furnish  a  perma- 
nent leg  when  a  permanent  leg  is  needed.    The  commission  will  also 
keep  these  artificial  legs  in  repair  and  will  replace  them  if  worn 
out  as  a  result  of  proper  use. 

420.  The  legs  furnished  will  be  of  approved  manufacture,  and  be- 
fore acceptance  by  the  commission  must,  where  practicable,  be  pro- 
nounced satisfactory  in  workmanship  and  fit  by  a  competent  ortho- 
pedic surgeon. 

421.  The  employee  should  be  advised  accordingly,  and  when  a  leg 
is  desired  authority  for  its  purchase  should  be  requested  from  the 
commission.     The  telegraph  may  be  used  to  expedite  such  requisi- 
tions. 

422.  When  an  employee  of  the  United  States  has  lost  an  arm  or 
part  of  an  arm  as  a  result  of  an  injury  for  which  he  is  entitled  to 
the  benefits  of  the  compensation  act,  the  Employees'  Compensation 
Commission  will  furnish  tin  artificial  arm.     The  commission  will 
also  keep  the  artificial  arm  in  repair  and  will  replace  it  if  worn 
out  as  a  result  of  proper  use. 

423.  The  arms  furnished  will  be  of  approved  manufacture,  and  be- 
fore acceptance  by  the  commission  must,  where  practicable,  be  pro- 
nounced satisfactory  in  workmanship  and  fit  by  a  competent  ortho- 
pedic surgeon. 

424.  The  employee  should  be  advised  accordingly,  and  when  an 
arm  is  desired  authority  for  its  purchase  should  be  requested  from 
the  medical  director  of  the  commission.    The  telegraph  may  be  used 
to  expedite  the  requisition. 

425.  "When  an  employee  of  the  United  States  has  lost  an  eye  as  a 
result  of  an  injury  for  which  he  is  entitled  to  the  benefits  of  the 
compensation  act,  the  Employees'  Compensation  Commission  will 
furnish  two  properly  fitting  and  matched  artificial  eyes,  one  to  be 
kept  for  use  in  cnse  of  accidental  lo^s  or  breakage  of  the  other. 

426.  The  eyes  furnished  will  be  of  approved  manufacture,  and  be- 
fore acceptance  by  the  commission  must,  where  practicable,  be  pro- 
nounced satisfactory  as  to  fit  and  color  by  a  competent  ophthal- 
mologist. 

427.  The  employee  should  be  advised  accordingly,  and  when  an  eye 
is  desired  authority  for  its  purchase  should  be  requested  from  the 
medical  director  of  the  commission.     The  telegraph  mav  bo  used  to 
expedite  such  requisitions. 

428.  Medical  treatment  to  which  injured  employees  am  entitled  in- 
cludes repairs  to  fixed  false  teeth  or  to  natural  teeth  only  hi  so  far 


64 

as  such  repairs  are  due  to  the  injury.  An  estimate  of  the  cost  of 
the  dental  work  should  be  approved  in  advance  as  reasonable  by  a 
medical  officer,  who  should  also  certify  on  the  bill  that  all  the  work 
Avas  needed  as  a  direct  result  of  the  injury  sustained  while  in  per- 
formance of  duty.  Bills  for  repairs  or  replacement  of  removable 
false  teeth  are  not  payable  from  the  compensation  fund. 

429.  Under  the  same  conditions  applying  to  artificial  limbs  and 
eyes,  the  Employees'  Compensation  Commission  will  furnish  other 
prosthetic  appliances  that  may  be  needed. 

430.  Orthopedic  braces,  orthopedic  shoes,  and  other  orthopedic  ap- 
pliances will  be  furnished  by  the  Employees'  Compensation  Com- 
mission under  the  same  conditions  and  in  the  same  way  as  are  pros- 
thetic appliances.     In  most  instances  the  matter  of  time  will  make 
it  advisable  for  the  attending  medical  officer  to  secure  immediately 
the  orthopedic  appliance  indicated  in  a  given  case.     When  this  is 
done  the  bill  therefor  should  be  forwarded  to  the  commission  for 
payment,  with  a  notation  thereon  that  the  article  was  necessary  be- 
cause of  the  injury,  that  it  Avas  satisfactory,  and  that  the  price  was 
reasonable. 

431.  Treatment  furnished  beneficiaries  of  the  compensation  act  of 
the  United  States  shall  be  reported  in  the  usual  manner  to  the  dis- 
trict supervisor  on  Forms  1971-E,  Outpatients  Report  Card,  and 
1971-F,  Inpatients  Report  Card.    On  such  reports  the  class  of  pa- 
tients shall  be  designated  or  shown,  and  authority  for  said  treat- 
ment shall  be  cited  as  "  employees'  compensation  act." 

432.  Treatment  furnished  said  patients  shall  be  taken  up  in  the 
Medical  Officer's  Monthly  Report  of  Relief,  Form  1922. 

433.  The  following  forms  will  be  used  by  medical  officers,  in  addi- 
tion to  Forms  1971-E  and  1971-F,  and  for  recording  and  reporting 
to  the  medical  director  of  the  Compensation  Commission  injuries  to 
civil  employees  of  the  Government,  beneficiaries  of  the  compensation 
act  under  treatment : 

Medical  Records  of  Injury  and  Treatment  (Form  CA-19).  The 
form  shall  be  filled  out  in  all  cases  where  an  injured  civil  em- 
ployee applies  for  treatment. 

The  name  of  the  officer  or  physician  making  the  examination  and 
diagnosis  should  be  recorded.  When  an  operation  is  performed, 
the  name  of  the  operator  and  his  official  status  and  recognized 
specialty,  if  any,  should  be  shown.  X-ray  examination  should 
be  made  in  all  cases  of  fractures,  suspected  fractures,  so-called 
"  sprains,"  whenever  bone  or  joint  injury  is  suspected  or  possible 
from  the  symptoms  and  in  any  case  where  it  would  aid  in  the 
diagnosis.  When  X-ray  examination  is  made,  the  fact  should, 
be  noted  and  findings  shown.  Photographic  prints  should  be 


65 

made  from  the  X-ray  plates  taken  in  the  case  and  forwarded  to 
the  medical  director,  Employees'  Compensation  Commission. 

In  all  injuries,  in  so  far  as  possible,  the  exact  location  and  extent 
should  be  recorded,  together  with  a  statement  of  the  extent  of  the 
disability  arising  therefrom.  In  fractures,  the  size  and  condition 
of  the  fragments,  both  before  and  after  reduction,  should  be 
given,  together  with  a  statement  whether  X-ray  examination  was 
made  and  whether  X-ray  plates  were  preserved.  Unless  there 
is  absolutely  no  indication  therefor,  X-ray  plates  showing  the 
antero-posterior  and  lateral  views  of  the  fragments  should  be 
kept.  X-ray  plates  and  photographic  prints  should  also  be  made 
when  the  patient  is  discharged  so  that  there  will  be  a  record  of 
the  condition  at  that  time.  In  lacerations,  the  location,  con- 
formation, extent  or  length,  and  depth  should  be  recorded. 

If  the  medical  officer  feels  confident  that  an  employee  is  not  en- 
titled to  the  benefits  of  the  compensation  act,  his  reasons  for  so 
thinking  shall  be  noted  under  "  Remarks."  Supplementary  case 
records  giving  a  more  detailed  clinical  history  of  the  case  should 
be  kept  in  all  instances  of  serious  injury.  (See  paragraph  on 
"  Supplementary  case  reports.") 

Medical  Report  of  Injury  to  United  States  Employee  (Form 
CA-20,  United  States  Employees'  Compensation  Commission.) 
This  report  shall  be  forwarded  to  the  medical  director  of  the 
commission  as  soon  as  a  case  comes  under  treatment. 

Discharge  Report  of  Injury  Case  (Form  CA-21,  United  States 
Employees'  Compensation  Commission,  when  an  injured  em- 
ployee is  transferred  or  discharged  from  treatment  or  the  case 
is  otherwise  terminated).  This  report  shall  be  forwarded  to  the 
medical  director  of  the  commission. 

434.  The  foregoing  reports  serve  their  purpose  only  when  for- 
warded promptly  to  the  United  States  Employees'  Compensation 
Commission.    If  the  forwarding  of  a  report  is  delayed  for  any  cause, 
it*  should  be  accompanied  by  a  letter  of  transmittal  explaining  the 
cause  of  the  delay. 

435.  Supplementary  case  reports  in  the  form  of  a  letter  should  be 
made  of  the  following  cases  to  the  medical  director,  United  States 
Employees'  Compensation  Commission : 

1.  All  compensation  cases  treated  in  hospitals. 

2.  All  cases  of  serious  injury. 

3.  All  cases  -in  which  there  will  be  a  disability  for  work  for  one 

month  or  more. 

4.  All  cases  sent  to  the  medical  officer  for  examination  under  the 

provisions  of  section  21  of  the  compensation  act. 
185279°— 20 5 


66 

436.  These  supplementary  reports  should  be  made  when  the  case 
has  been  under  observation  for  a  sufficient  time  to  determine  satis- 
factorily the  nature  and  extent  of  the  injury.    The  reports  should 
include: 

1.  Date  when  case  was  admitted  for  examination  or  treatment.    If 

admitted  to  hospital,  this  should  be  noted. 

2.  The  patient's  complaint,  including  his  account  of  the  injury. 

3.  The  names  (and  specialists,  if  any)  of  the  physicians  or  officers 

examining  the  case. 

4.  The  condition  found  on  examination. 

5.  Diagnosis  of  the  injuries  sustained. 
(>.  Xature  and  extent  of  disability. 

7.  Whether  disabled  for  his  usual  employment. 

8.  Prognosis. 

0.  Comments,  recommendations,  or  suggestions  regarding  the  case. 

437.  For  specimen  copies  of  reports,  furnishing  the  information 
necessary  for  the  proper  handling  of  the  cases  by  the  Employees' 
Compensation  Commission,  see  appendix. 

438.  Whenever  a  photograph  of  an  injured  part  not  considered 
necessary  in  connection  with  medical  care  and  treatment  would  nev- 
ertheless be  of  value  in  the  determination  of  compensation,  and 
facilities  are  available,  a  photograph  should  be  made  and  a  print 
thereof  furnished  to  the  medical  director  of  the  commission,  the 
expense  to  be  charged  to  the  Employees'  Compensation  Commission. 

439.  Whenever  the  services  of  an  attending  specialist  are  secured 
in  connection  with  the  examination  or  treatment  of  a  beneficiary  of 
the  compensation  act,  a  brief  statement  by  the  attending  specialist 
of  his   findings   at   examination    and   his   recommendations    as   to 
treatment  should  be  given  in  the  report  of  the  case  when  forwarded 
by  the  medical  officer  or  designated  physician  in  charge  thereof.    The 
name  and  recognized  specialty  of  the  attending  specialist  should  be 
indicated  and  the  statement  should  include : 

1.  Diagnosis  of  the  disability  and  its  relationship  to  the  alleged 

injury. 

2.  Prognosis. 

3.  Recommendation  as  to  treatment. 

4.  Statement  as  to  whether  patient  is  disabled  for  usual  occupation. 

5.  Comment  or  remarks. 

440.  When  it  is  in  the  interest  of  economy  and  efficiency  and  to  the 
welfare  of  injured  civil  employees  of  the  United  States,  the  Employ- 
ees' Compensation  Commission  will  order  the  transfer  of  such  patients 
from  one  station  to  another.     The  necessary  expenses  involved  in 
such  transfer  will  be  chargeable  to  the  commission.    No  injured  em- 
ployee should  be  so  transferred  without  the  authorization  of  the 


67 

commission.     (Authority  may  be  obtained  by  telegraphing  the  medi- 
cal director,  United  States  Employees'  Compensation  Commission.) 

441.  All  injured  employees  will  be  treated  either  as  dispensary  or 
office  patients  or  as  hospital  patients,  and  no  injured  employee  will 
be  furnished  treatment  in  his  home  unless  such  arrangement  is  ap- 
proved by  the  medical  director  of  the  commission  or  unless,  in  the 
opinion  of  the  medical  officer  in  charge  of  the  case,  treatment  at 
home  is  the  only  course  practicable  in  the  circumstances  and  the 
reasons  for  home  treatment  are  reported  to  the  commission. 

442.  When  there  is  in  the  general  locality  of  the  relief  station  a 
Government  establishment  with   any  considerable  number  of  em- 
ployees arrangements  should  be  made  with  the  officer  in  charge  of 
the  establishment  whereby  there  will  be  adequate  ambulance  service, 
if  needed  on  account  of  injury  cases  entitled  to  benefits  of  the  com- 
pensation act.    If  the  station  has  no  ambulance,  any  other  arrange- 
ment practicable  can  be  made  and  bills  on  account  of  necessary  ex- 
penditures incurred  by  said  arrangement  forwarded  to  the  commis- 
sion in  the  usual  way. 

443.  Injured  employees  frequently  present  themselves  for  exami- 
nation and  treatment,  and  no  anatomical  lesion  resulting  from  an 
injury  is  found.    The  diagnosis  recorded  in  such  cases  is  frequently ' 
"  no  disability  present  "  or  "  traumatic  neurosis,"  or  perhaps  "  case  of 
malingering." 

444.  In  a  proportion  of  these  cases  the  diagnosis  is  the  resXilt  of 
the  limitations  of  diagnosis  and  not  due  to  the  fact  that  an  actual 
injury  does  not  exist.    In  many  instances  the  Employees'  Compensa- 
tion Commission  finds  that  on  further  and  more  detailed  examination 
a  definite  lesion  is  found.    These  cases  of  what  amounts  to  negative 
diagnosis  are  among  those  giving  the  commission  the  greatest  amount 
of  trouble.    The  injured  employee  insists  he  is  injured  and  the  com- 
mission is  unwilling  to  deny  his  claim  until  it  has  exhausted  the  pow- 
ers of  diagnosis.    It  is,  therefore,  necessary  in  cases  of  this  kind  that 
the  negative  diagnosis  be  supported  by  a  very  complete  examination, 
the  results  of  which  are  made  a  matter  of  careful  record.    It  is  in 
cases  of  this  kind  that  the  services  of  attending  specialists  are  most 
needed.    Back  injuries  are  among  those  causing  much  trouble  in  this 
way.    The  surgeon  of  lesser  experience  finds  no  disabling  condition. 
The  experienced  orthopedic  surgeon  looks  for  the  injured  sacro  iliac 
joint  or  fractured  vertebra  in  these  injuries  and  frequently  finds 
them.    This  makes  necessary  the  services  of  an  expert  roentgenologisfc 
and  expert  reading  of  the  plates. 

445.  In  caring  for  beneficiaries  of  the  compensation  act  chief  con- 
sideration is  to  be  given  to  the  repairing  of  the  damage  due  to  the 
injury  and  to  the  restoration  of  function,  in  so  far  as  possible,  to  the 


injured  part  in  the  best  interest  of  the  injured  employee.  Where  the 
injury  is  of  such  a  nature  that  it  can  be  treated  best  by  a  specialist, 
the  services  of  an  attending  specialist  will  be  secured  to  take  charge 
of  the  case. 

446.  Where  available,  eye  injuries  will  be  treated  by  ophthalmolo- 
gists, bone  and  joint  injuries  by  trained  orthopedic  surgeons  or  by 
surgeons  having  ample  experience. 

447.  In  the  treatment  of  injured  employees  limbs  or  parts  of  limbs 
will  not  be  amputated  unless  it  appears  to  be  in  the  interest  of  the 
employee.    Whenever  an  amputation  is  necessary,  a  careful  and  com- 
plete record  will  be  made  of  all  the  circumstances  requiring  the  am- 
putation.   In  addition  to  the  written  record  of  the  nature  and  extent 
of  injury  and  the  necessity  for  amputation,  a  photograph  of  the  in- 
jured member,  and  where  indicated  an  X-ray  examination,  should  be 
made,  and  copies  of  the  record  and  of  the  photograph,  including  a 
print  from  the  X-ray  negative,  should  be  sent  to  the  medical  director 
of  the  commission  for  filing  Avith  the  record  of  the  case. 

448.  In  all  cases  of  fractured  bones  adequate  X-ray  examination 
will  be  made  and  X-ray  plates  preserved  for  record.     During  the 
.course  of  treatment  of  the  fracture  if  other  X-ray  examinations  are 
indicated  they  should  be  made.    When  union  shall  have  taken  place 
and  convalescence  been  established,  and  before  the  case  is  discharged 
from  treatment,   further   X-ray   plates  showing  both  the   antero- 
posterior  and  lateral  views  of  the  fragments  will  be  made.    Photo- 
graphic prints  from  all  plates  showing  the  injury  should  be  for- 
warded to  the  medical  director  of  the  commission  for  filing  with  the 
other  records  in  the  case.    Film  negatives  may  be  forwarded  instead 
of  prints.    Each  photograph  should  have  noted  thereon  the  patient's 
full  name  and  the  date  when  taken. 

449.  X-ray  examinations  should  be  made  in  injuries  where  fracture 
is  suspected  or  thought  possible  and  the  negatives  kept  as  a  part  of 
the  record  of  the  case. 

450.  In  sprains,  or  injuries  believed  to  be  sprains,  unless  examina- 
tion shows  that  there  is  absolutely  no  reason  to  suspect  a  fracture, 
X-ray  examination  should  be  made  and  negative  kept  as  a  part  of  the 
record. 

451.  When  plastic  operations  are  to  be  performed,  arrangements 
will  be  made  by  the  medical  officer  in  charge  to  have  photographs 
taken  showing  the  condition  before  operation.    Photographs  should 
also  be  made  subsequent  to  the  operation  and  before  the  patient  is 
discharged  from  treatment.    Unmounted  copies  of  these  photographs 
taken  both  before  and  after  operation  should  be  forwarded  to  the 
medical  director  of  the  commission  as  a  part  of  the  recoro!  and  for 
filing  with  the  other  papers  in  the  case.    These  photographs  should 


69 

have  written  on  the  back  the  full  name  of  the  patient  and  the  date 
when  taken. 

452.  Where  expense  is  incurred  on  account  of  these  photographs, 
bills  will  be  sent  to  the  Employees'  Compensation  Commission  for 
payment,  preferably  at  the  time  the  photographs  are  forwarded. 

453.  In  mutilating  or  disfiguring  injuries  the  medical  officer  in 
charge  will  have  an  unmounted  photograph  made  showing  the  nature 
of  the  mutilation  or  disfigurement  and  will  send  it  to  the  medical 
director  of  the  commission  as  a  part  of  the  record  and  for  filing  with 
the  other  papers  in  the  case.    These  photographs  should  have  written 
on  the  back  the  full  name  of  the  patient  and  the  date  when  taken. 

454.  Where  expense  is  incurred  on  account  of  these  photographs, 
bills  will  be  sent  to  the  Employees'  Compensation  Commission  for 
payment,  preferably  at  the  time  the  photographs  are  forwarded. 

455.  In  a  large  proportion  of  hernia  cases  there  is  considerable 
doubt  as  to  whether  the  case  is  one  entitled  to  treatment  under  the 
compensation  act.    Therefore,  unless  the  relationship  of  the  hernia  to 
the  injury  is  clear,  or  unless  immediate  treatment  is  necessary  because 
of  strangulation  or   incarceration  or   for  other  reason,  operation 
should  not  be  performed  until  a  full  report  of  the  case  has  been  sub- 
mitted to  the   Employees'   Compensation   Commission   and   it   has 
authorized  operation. 

456.  Pending  decision  on  the  case,  the  patient  should  be  discharged 
from  hospital,  if  practicable.     The  initial  report  to  the  commission 
should  show: 

(1)  The  nature  and  location  of  the  hernia. 

(2)  Tissues  involved  and  the  extent  or  size  of  the  hernia. 

(3)  The  cause  of  the  hernia,  particularly  whether  brought  on  or 
materially  aggravated  by  injury  as  alleged  by  the  claimant. 

(4)  Whether  the  hernia  is  one  for  which  operation  should  be  per- 
formed. 

(5)  Whether  patient's  general  health,  including  condition  of  his 
lieart,  lungs,  and  kidneys,  is  such  that  it  is  advisable  to  perform 
operation. 

(6)  Whether  the  medical  officer  recommends  operation. 

457.  For  nature  of  the  evidence  required  in  hernia  cases  to  entitle 
the  patient  to  treatment  under  the  compensation  act,  see  appendix. 

458.  In  those  cases  requiring  the  services  of  a  specialist  for  pur- 
poses of  diagnosis  or  treatment,  the  jnedical  officer  in  charge  will 
obtain  such  services. 

459.  Whenever  an  employee  applies  for  treatment  with  a  request 
for  treatment  on  Form  C.  A.  16,  or  a  letter  of  request  from  his  official 
superior,  the  employee  should  be  furnished  such  treatment  as  may 
be  required ;  but  if  there  is  reason  to  believe  that  he  is  not  entitled  to 


70 

treatment  or  that  his  disability  is  not  due  to  the  alleged  injury,  the 
medical  officer  should  take  up  the  matter  with  the  employee's  official 
superior.  If  agreement  is  reached  by  both  that  the  employee  is  not 
entitled  to  relief,  he  should  be  discharged  from  treatment,  unless 
satisfactory  arrangements  can  be  made  to  continue  treatment  with- 
out further  charge  against  the  Employees'  Compensation  Commis- 
sion. Written  records  should  be  kept  and  immediate  report  made  of 
all  such  cases  to  the  medical  director  of  the  commission.' 

460.  If  an  injured  employee  admitted  to  a  United  States  marine 
or  Public  Health  Service  hospital  for  treatment  on  account  of  injury 
refuses  to  comply  with  any  hospital  rule  or  requirement  and  his 
offense  is  of  sufficient  gravity  to  justify  his  dismissal  from  the  hos- 
pital, the  medical  officer  in  charge  of  the  hospital  will  telegraph  the 
medical  director  of  the  commission  24  hours  in  advance  of  the  con- 
templated dismissal  in  sufficient  detail  to  acquaint  the  commission 
with  the  circumstances  surrounding  the  proposed  discharge  of  the 
patient  and  to  enable  it  to  take  necessary  action. 

461.  Whenever,  in  any  case,  an  injured  employee  admitted  to  hos- 
pital is  found  to  have  or  develops  a  disease  or  disability  which  is  not 
related  to  the  injury  and  which  is  liable  to  prolong  his  stay  in  hos- 
pital, the  commission  should  be  notified  immediately. 

462.  Whenever  an  injured  employee  becomes  physically  fit  to  do 
light  work  or  some  form  of  work  other  than  his  usual  Avork  without 
detriment  to  himself  and  without  interfering  writh  his  recovery  from 
the  injury,  the  medical  officer  in  charge  of  the  case  should  record  the 
fact  in  the  clinical  history  and  should  notify  the  patient,  the  em- 
ployer, and  the  commission. 

463.  Insane  injured  employees  entitled  to  the  benefits  of  the  com- 
pensation act  will  be  transferred  either  to  a  United  States  marine  or 
Public  Health  Service  hospital  for  the  insane.     Requests  for  such 
transfer  should  in  each  case  be  made  to  the  medical  director  of  the 
commission  by  the  medical  officer  in  charge. 

PATIENTS  OF  THE  BUREAU  OF  WAR  RISK  INSURANCE. 

464.  The  term  "  patients  of  the  Bureau  of  War  Risk  Insurance " 
as  used  in  Public  Act  326  of  the  Sixty-fifth  Congress  shall  be  held  to 
mean,  subject  to  the  limitations  contained  in  paragraphs  465  and  466 : 

(a)  Any  discharged  sick  and  disabled  soldier,  sailor,  marine, 
Army  or  Navy  nurse  (male  or  female)  applying  for  compensation 
for  personal  injury  suffered  or  disease  contracted  in  the  line  of  duty 
and  not  the  result  of  his  own  willful  misconduct,  and  until  such  time 
as  claim  for  compensation  has  been  disallowed.  The  above  authori- 
zation is  intended  to  cover  emergency  cases  in  which  the  health  of 
the  patient  would  be  seriously  injured  by  delay.  Great  care  should, 


71 

however,  be  exercised  in  the  utilization  of  this  authorization,  the 
patient's  discharge  and  other  papers  being  carefully  examined  to 
prevent,  in  so  far  as  possible,  persons  falling  within  the  limitations 
of  paragraphs  465  and  466  from  receiving  treatment. 

(5)  Any  person  who,  after  induction  by  a  local  draft  board,  but 
before  being  accepted  and  enrolled  for  active  service  became  dis- 
abled as  the  result  of  disease  contracted  or  injury  suffered  in  the 
line  of  duty  and  not  the  result  of  his  own  willful  misconduct  in- 
volving moral  turpitude  or  as  a  result  of  the  aggravation  in  the  lino 
of  duty  and  not  because  of  his  own  willful  misconduct  involving 
moral  turpitude  of  an  existing  disease  or  injury. 

(c)  Any  such  person  in  whose  favor  an  award  of  compensation 
has  been  made,  or  to  whom  a  certificate  of  injury  has  been  issued  by 
the  Bureau  of  War  Eisk  Insurance. 

(d)  Any  such  compensable  person  who  has  waived  his  rights  to 
compensation.     Patients  falling  in  classes  (a),  (6),  (e),and  (d)  will 
be  treated  only  for  conditions  definitely  connected  with  their  military 
service  or  for  intercurrent  conditions  having  an  untoward  effect  upon 
the  cure  or  amelioration  of  conditions  definitely  connected  with  their 
military  service. 

(e)  Discharged  members  of  the  military  or  naval  forces  of  those 
Governments  which  have  been  associated  in  war  with  the  United 
States  since  April  6, 1917,  subject  to  such  regulations  as  the  Director 
of  the  Bureau  of  War  Risk  Insurance  may  prescribe. 

465.  Discharged  sick  and  disabled  soldiers,  sailors,  marines,  Army 
or  Navy  nurses  (male  or  female)  are  rendered  ineligible  as  patients 
of  the  Bureau  of  War  Risk  Insurance  by  any  of  the  following : 

(a)  Discharge  prior  to  April  6,  1917. 

(b)  Discharge  or  dismissal  from  the  military  or  naval  forces  as 
enemy  alien,  conscientious  objector,  or   deserter,  or  as  guilty  of 
mutiny,  treason,  spying,  or  any  offense  involving  moral  turpitude 
or  willful  and  persistent  misconduct. 

*(c)  Dismissal  or  dishonorable  or  bad  conduct  discharge  from  the 
service. 

(d)  Refusal  to  submit  to,  or  obstruction  of  physical  examination. 

466.  Persons  contracting  a  venereal  disease  while  in  the  military 
service,  unless  it  can  be  shown  to  have  been  wholly  accidental  and 
not  clue  to  a  voluntary  act,  are  not  entitled  to  care  and  treatment  by 
the  Public  Health  Service.     If  venereal  disease  was  contracted  prior 
to  enlistment,  but  the  person  was  nevertheless  accepted  as  sound  for 
active  service,  he  is  entitled  to  care  and  treatment  by  the  Public 
Health  Service.    If,  however,  such  disability  was  noted  at  the  time 
of  his  enlistment  and  he  was  subsequently  accepted  for  service,  sub- 
ject to  such  disability,  he  is  entitled  to  treatment  only  for  an  aggrava- 
tion of  the  disability  noted  incurred  while  in  the  military  service. 


72 

467.  Claimants  applying  for  compensation  will-  be  required,  when 
able,  to  fill  out  an  application  blank,  Bureau  of  War  Risk  Insurance 
Form  No.  526,  which  will  be  forwarded  by  the  examiner  to  the  chief 
medical  adviser,  Bureau  of  War  Risk  Insurance.    The  examination 
will  then  be  made  upon  the  prescribed  form,  and  after  its  completion, 
if  the  claimant  is  in  need  of  relief,  the  kind  of  treatment  required, 
either  outpatient  or  hospital,  will  be  furnished  by  the  medical  officer 
in  charge  of  the  station  to  which  the  claimant  is  referred  for  treat- 
ment. 

468.  If  the  applicant  requires  only  outpatient  relief  and  there  is  no 
service  station  nearby  where  he  can  receive  such  relief,  a  designated 
examiner  is  authorized  to  furnish  him  treatment,  giving  him  a  pre- 
scription if  necessary,  to  a  local  druggist  for  such  medicine  as  is  re- 
quired.   Vouchers  for  prescriptions  shall  be  rendered  at  the  end  of 
each  month  on  Form  1949  and  shall  bear  patient's  name  and  prescrip- 
tion number.    Copies  of  prescription,  with  price  of  each  marked  there- 
on, shall  accompany  such  vouchers. 

469.  Examinations  shall  be  complete,  and  examiners  are  authorized 
to  hold  any  claimant  under  observation  for  such  temporary  period  as 
is  necessary  to  arrive  at  a  definite  conclusion.    It  should  be  remem- 
bered, that  a  claimant  can  not  be  held  against  his  will.    He  should, 
however,  be  informed  that  if  he  refuses  to  submit  himself  for,  or 
in  any  way  obstruct  any  examination,  his  right  to  claim  compen- 
sation shall  be  suspended  until  such  refusal  or  obstruction  ceases. 

470.  The  examiner  shall,  in  every  case,  inform  the  claimant  in  de- 
tail as  to  the  procedure  likely  to  become  necessary  if  the  patient  is  ad- 
mitted to  a  hospital.    The  examiner  shall  convey  the  impression  to  the 
patient  that  he  is  interested  in  his  welfare,  but  shall  carefully  refrain 
from  implanting  in  the  patient's  mind  the  idea  that  the  patient's  en- 
trance into  a  hospital  is  solicited.    The  final  decision  of  entering  the 
hospital  is  a  prerogative  that  must  be  exercised  in  all  cases  by  the 
patient  himself,  without  any  coercion  upon  the  part  of  the  examiner. 
Examiners  are  not  authorized  to  make  promises  of  transfers  to  in- 
stitutions and  localities  desired  by  patients. 

471.  Claimants  who  have  suffered  some  injury  or  illness  in  service, 
not  due  to  their  own  misconduct,  which  may  at  a  future  date  cause 
disability  or  death,  will  be  given  an  original  examination  at  their 
own  request  for  the  purpose  of  establishing  claim  to  a  certificate  of 
injury  after  presentation  of  an  honorable  discharge,  or  a  copy  thereof, 
dated  on  or  after  April  6, 1917. 

472.  Examiners  shall  not  discuss  with  any  patient  the  extent  of  the 
disease  or  injury  from  which  such  patient  is  suffering,  and  shall  not 
make  any  statement  which  the  patient  could  use  for  the  purpose  of 
showing  a  difference  of  opinion  between  the  Bureau  of  War  Risk  In- 
surance and  the  examiner. 


73 

473.  No  patients  shall  be  sent  for  treatment  to  hospitals  outside  of 
the  district  where  they  reside,  except  when  the  approval  of  the  Sur- 
geon General  of  the  Public  Health  Service  or  of  the  Chief  Medical 
Adviser  of  the  Bureau  of  War  Risk  Insurance  has  been-  previously 
obtained.    Mental  and  neuropsychiatric  cases  are  excepted  from  this 
rule. 

474.  A  written  report  of  every  examination  of  a  claimant  of  the 
Bureau  of  War  Risk  Insurance  shall  be  prepared  in  duplicate  on 
Form    1934—B    Report    of    Physical    Examination.      Great    care 
should  be  taken  in  order  that  this  report  shall  be  accurately  and 
legibly  prepared.    Immediately  on  conclusion  of  the  examination  the 
original  shall  be  mailed  direct  to  the  district  supervisor,  and  the 
duplicate  shall  be  filed  at  the  office  of  the  examiner.    An  exception 
to  the   foregoing  rule  is  made  in  neuropsychiatric   examinations. 
Owing  to  the  complex  nature  of  the  information  needed  for  the 
proper  disposition  of  these  cases,  reports  of  such  examinations  will 
be  made  to  the  district  supervisor  on  a  special  form.    The  above  re- 
ports are  required  in  addition  to  Form  1971-E,  Outpatient  Report 
Card. 

475.  Every  report  of  a  physical  examination  should  be  sufficiently 
comprehensive  and  contain  sufficient  data  to  enable  the  Bureau  of 
War-Risk  Insurance  to  form  an  adequate  judgment  of  the  claimant's 
condition. 

476.  It  is  essential  that  the  official  Nomenclature  of  Diseases  and 
Conditions,  1916  be  referred  to  in  making  diagnoses  in  order  that 
the  proper  name  and  number  of  the  disease  or  condition  may  be  given 
in  each  instance. 

477.  A  dental  officer  will  be  assigned  to  each  district  to  act  under 
the  direction  of  the  district  supervisor  for  the  conduct  of  all  service 
dental  operations  in    the  district,    including    the    maintenance    of 
records,  the  inspection  of  dental  clinics,  and  the  nomination  of  dental 
examiners  to  the  district  supervisor. 

478.  One  or  more  dental  officers  will  be  assigned  to  each  of  the 
hospitals  of  the  service,  where  the  demand  for  dental  treatment  is 
great  enough  to  warrant  such  action. 

479.  One  or  more  dental  officers  will  be  assigned  to  each  out-patient 
office  when  the  demand  for  dental  treatment  is  great  enough  to  war- 
rant such  action. 

480.  In  large  cities  where  no  service  hospital  or  district  super- 
visor's office  is  located,  a  dental  officer  will  be  assigned  to  some  insti- 
tution with  which  the  service  has  a  contract,  if  the  demand  for  dental 
treatment  in  that  station  is  great  enough  to  warrant  such  action. 


74 

481.  To  care  for  beneficiaries  in  rural  communities  or  in  cities 
where  no  dental  officer  is  assigned,,  civilian  dentists  may  be  appointed 
as  dental  examiners  to  do  dental  work  on  a  iee  basis.    This  organiza- 
tion will  be  built  up  under  the  direction  of  the  Surgeon  General  by 
the  supervising  dental  surgeon  in  each  district,  and  a  dentist  will  be 
appointed  to  act  as  dental  examiner  in  each  county.    Civilian  dentists 
appointed  as  dental  examiners  must  be  made  to  understand  that  aty 
patients  of  the  Bureau  of  War  Risk  Insurance  referred  to  them  must 
be  treated  as  private  patients,  and  their  wishes  must  be  respected  in 
the  matter  of  appointment  hours. 

482.  No  dental  examiners  will  be  appointed  other  than  ©n  a  fee 
basis,  and  whenever  it  is  deemed  best  for  the  good  of  the  service  to 
discontinue  the  services  of  a  dental  examiner,  the  district  supervisor 
should  make  such  recommendation  to  the  Surgeon  General  for  neces- 
sary action* 

483.  Dental  blank  forms  with  spaces  for  diagnosis  of  oral  condi- 
tions, detailed  statement  of  dental  treatment  indicated,  fees  to  be 
charged  according  to  the  fee  table  authorized  by  the  Secretary  of  the 
Treasury,  detailed  statement  of  dental  treatment  rendered,  a  brief 
history  of  the  patient,  etc.,  will  be  furnished  by  the  Surgeon  General 
and  sent  to  each  dental  examiner  by  the  district  supervisor. 

484.  When  a  patient  applies  for  dental  treatment  to  the  district 
supervisor  he  will  be  referred  to  the  dental  examiner  nearest  to  his 
home.     The  dental  examiner  will  make  a  thorough  examination  of 
oral  conditions  and  record  said  examination  on  the  dental  blank.    If 
the  cost  of  dental  treatment  needed  does  not  exceed  $10,  the  dental 
examiner  will  render  the  treatment  and  forward  the  finished  blank  to 
the  district  supervisor's  office,  where  four  copies  shall  be  made,  one 
for  the  files  of  the  district  supervisor's  office  and  three  to  be  for- 
warded with  the  original  to  the  Surgeon  General  for  necessary  action. 
One  copy  will  be  forwarded  to  the  Chief  Medical  Adviser  of  the  Bu- 
reau of  War  Risk  Insurance. 

485.  If  the  cost  of  dental  treatment  exceeds  $10,  the  blank  with 
recorded  examination,  indicated  treatment,  and  cost  thereof  shall  be 
forwarded  to  the  district  supervisor.     All  estimates  not  exceeding 
$100  will  be  authorized  by  the  district  supervisor,  after  same  have 
been  passed  on  by  the  supervising  dental  surgeon.    Due  care  will  be 
observed  in  determining  the  serviqe  origin  or  aggravation  of  the 
condition  to  be  treated,  and  when  doubt  exists  the  case  will  be  re- 
ferred to  the  Chief  Medical  Adviser  of  the  Bureau  of  War  Risk  In- 
surance for  decision.    All  estimates  exceeding  $100  will  be  sent  to 
the  Surgeon  General  for  authority  to  render  treatment. 

486.  When  authority  has  been  granted  either  by  the  district  super- 
visor or  by  the  Surgeon  General,  the  letter  of  authority  from  either 


75 

!  office  should  be  forwarded  immediately  with  the  original  blank  to 
the  dental  examiner,  requesting  immediate  treatment  of  the  patient. 

487.  Upon  completion  of  the  treatment  the  blank  will  be  made  out 
in  due  form  and  forwarded  to  the  district  supervisor  by  the  dental 
examiner,  where  four  copies  shall  be  made,  one  for  the  files  of  the 
district  supervisor's  office  and  three  to  be  forwarded  with  the  original 
to  the  Surgeon  General  for  necessary  action.    One  copy  will  be  for- 
Avarded  to  the  Chief  Medical  Adviser  of  the  Bureau  of  War  Bisk 
Insurance. 

488.  All  persons  concerned  will  assure  themselves  before  treatment 
is  given  that  the  patient  to  be  treated  has  made  claim  for  compen- 
sation or  a  certificate  of  injury,  or  has  received  an  award  of  com- 
pensation or  a  certificate  of  injury.    In  all  correspondence  with  the 
Bureau  of  War  Risk  Insurance  relative  to  its  claimants  the  "  C  " 
number  of  the  patient  should  be  stated. 

489.  Dental  patients  of  the  Bureau  of  War  Risk  Insurance  should 
be  classed   as  follows,  as  to  conditions  entitling  them  to   receive 
treatment : 

Class  1.  Those  patients  who  have  lost  teeth  or  portions  of  either 
maxilla  or  mandible  through  gunshot  wounds  or  other  injuries  re- 
ceived in  line  of  duty,  shall  have  restorations  and  such  other  dental 
treatment  as  may  be  necessary  to  put  the  mouth  in  the  best  condition 
possible. 

Class  2.  Those  patients  whose  physical  disability  is  directly  due 
to  pathological  oral  conditions  shall  have  whatever  dental  treatment 
js  necessary  to  place  the  mouth  in  a  healthy  condition  and  insure 
a  good  masticating  surface. 

Class  3.  Those  patients  the  relief  of  whose  disability  is  retarded 
by  pathological  oral  condition  shall  have  whatever  dental  treatment 
is  necessary  to  place  the  mouth  in  a  healthy  condition  and  insure  a 
good  masticating  surface. 

Class  4.  All  patients  who  are  shown  to  have  lost  teeth  while  in 
the  service  other  than  mentioned  in  class  1,  shall  have  the  same 
replaced  with  vulcanite  dentures  or  bridge  work. 

Class  5.  All  patients  of  the  Bureau  of  War  Risk  Insurance  whose 
teeth  are  shown  to  have  decayed  while  in  the  service,  shall  receive 
such  treatment  as  is  necessary. 

490.  No  precious  metals  shall  be  used  for  purely  cosmetic  reasons 
in  rendering  dental  treatment  to  any  of  the  above  five  classes. 

491.  When  the  dental  examiner  is  caring  for  the  patients  referred 
to  him,  he  is  requested  to  give  each  patient  a  short  talk  on  the  value 
of  the  teeth  and  the  necessity  for  the  care  of  same.     Pamphlets  of 
instruction  for  distribution  among  dental  patients  will  be  furnished 
in  sufficient  quantities  by  the  Surgeon  General  to  each  dental  ex- 


aminer. 


76 

492.  Prophylactic  treatment  will  be  allowed  only  to  such  patients 
of  the  Bureau  of  War  Risk  Insurance  as  have  a  disease  of  the  tissues 
of  the  mouth,  contracted  while  in  the  service,  or  patients  who  are 
under  treatment  for  a  physical  ailment,  whose  recovery  might  be 
retarded  by  an  unhealthy  oral  condition. 

493.  No  teeth  shall  be  extracted  without  using  either  infiltrative, 
conductive,  or  general  anesthesia. 

494.  No  extraction  shall  be  made  of  teeth  that  have  become  diseased 
since  the  patient's  discharge  from  the  service,  unless  the  jnedical 
officer  believes  that  the  diseased  tooth  is  related  to  a  systemic  condi- 
tion which  he  is  treating. 

495.  All  alloy  fillings  shall  be  polished  and  have  a  perfect  contact 
and  occlusion,  and  shall  be  carved  to  the  original  contour  of  the 
tooth. 

496.  Gold  fillings  (cast  or  malleted) :  No  gold  fillings  will  be  placed 
in  other  than  the  12  anterior  teeth,  and  tJhen  only  when  cavity  extends 
to  incisal  edge. 

497.  All  cavities  shall  be  lined  with  Caulk's  cavity  lining  or  equal 
before  placing  synthetic  porcelain  fillings. 

498.  No  gold  shell  crowns  shall  be  placed  other  than  for  an  abut- 
ment for  a  bridge. 

499.  Removal  of  pulp  and  filling  canals :  No  teeth  shall  be  devital- 
ized for  the  purpose  of  placing  crowns,  bridge  work,  or  attachments 
for  removal  work. 

500.  No  cement  or  gutta-percha  fillings  shall  be  placed,  except  for 
the  sealing  in  of  treatments. 

501.  No  fixed  bridge  work  shall  be  done  except  to  replace  lost 
incisors. 

502.  No  gold  shall  be  used  for  inlays  under  22  carats.     No  gold 
shall  be  used  for  crowns  under  22  carats,  30  gauge.    No  solder  shall 
be  used  under  18  carats.     All  cast  clasps  shall  be  of  Ney  Oro-E  cast 
clasp  metal  or  equal. 

503.  The  teeth  to  be  used  on  all  vulcanite  dentures  shall  be  of  an 
"A"  grade  of  procelain  and  alloy  pins. 

504.  In  case  there  is  a  loss  of  all  posterior  teeth  in  either  upper  or 
lower  jaw,  vulcanite  dentures  should  be  placed  with  cast-gold  clasps 
or  other  efficient  attachments. 

505.  No  dentures  shall  be  placed  with  attachment  or  clasp  over 
any  tooth  that  has  not  been  proven  healthy.    If  there  is  any  suspicion 
that  the  teeth  involved  in  restoration  are  not  healthy,  radiographs 
should  be  taken  of  same. 

506.  In  cases  being  treated,  where  the  medical  officer  suspects  a 
relationship  between  oral  conditions  and  the  general  health  of  patient, 
all  teeth  should  be  carefully  examined,  and  any  suspected  should  be 


77 

radiographed.  Where  it  is  found  necessary  to  extract,  the  relation- 
ship of  local  infections  to  the  general  health  and  the  necessity  for 
extraction  and  currettement  of  sockets  should  be  carefully  explained 
to  the  patient,  that  he  may  understand  that  the  loss  of  diseased  teeth 
is  for  his  own  good. 

507.  In  cases  where  there  has  been  a  loss  of  a  great  number  of 
teeth  or  portions  of  either  maxilla  or  mandible,  or  where  any  extraor- 
dinary condition  exists  that  is  not  included  in  the  fee  table,  the  exam- 
iner shall  furnish  a  complete  description  of  the  condition  found  and 
a  detailed  description  of  the  mechanical  work  contemplated  and  an 
estimated  cost  of  same,  to  the  district  supervisor  for  action. 

508.  All  correspondence  from  field  officers  with  the  Chief  Medical 
Adviser,  Bureau  of  War  Eisk  Insurance,  shall  be  addressed  to  "  The 
Chief  Medical  Adviser,  Bureau  of  War  Risk  Insurance,  Washington, 
D.  C."    Letter  should  be  briefed  as  follows : 

From:  (Writer). 

To :  Chief  Medical  Adviser. 

Subject : 

509.  Correspondence  with  the  Public  Health   Service,  with  the 
Bureau  of  War  Risk  Insurance,  or  with  others  interested  in  the  treat- 
ment of  beneficiaries  of  the  Bureau  of  War  Risk  Inusrance,  must 
furnish  the  following  information  in  connection  with  any  individual 
claimant:  (a)  Full  name;  (b)  present  emergency  address ;  (c)  rank 
and  organization;  (d)  date  of  discharge;   (e)  claim  number,  if  as- 
signed. 

510.  Separate  and  individual  letters  or  reports  shall  be  submitted 
in  connection  Avith  claimants  of  the  Bureau  of  War  Risk  Insurance, 
and  no  letter  or  report  shall  refer  to  more  than  one  claimant. 

511.  Duplicates  or  carbon  copies  of  all  correspondence  relating  to 
War  Risk  cases  shall  be  kept  at  all  stations  where  claimants  are  cared 
for,  and  a  special  file  maintained  for  this  purpose. 

PATIENTS  FOR  SPECIAL  STUDY  AND   INVESTIGATION. 

512.  There  may  be  admitted  into  United  States  Public  Health 
Service  and  marine  hospitals  for  study  persons  with  infectious  or 
other  diseases  affecting  the  public  health,  not  to  exceed  10  cases  in  any 
one  hospital  at  one  time.    The  Surgeon  General  shall  in  each  instance 
designate  the  hospitals  to  be  used  for  this  purpose  and  the  diseases 
to  be  studied. 


78 
ARTICLE  XI. 

OFFICERS  AND  ENLISTED  MEN  OF  THE  UNITED  STATES  ARMY 
AND  NAVY,  FOREIGN  SEAMEN,  BENEFICIARIES  OF  THE  FED- 
ERAL BOARD  FOR  VOCATIONAL  EDUCATION. 

UNITED  STATES  ARMY  AND  NAVY. 

513.  Officers  and  enlisted  men  of  the  United  States  Army  and 
Xavy,  and  civilian  officers  and  crews  of  naval  auxiliary  vessels,  may 
be  admitted  for  care  and  treatment  as  patients  of  the  service  only 
upon  the  written  request  of  their  respective  commanding  officers. 
Every  sueji  admission  shall  be  immediately  reported  to  the  district 
supervisor  by  the  officer  .in  charge  of  the  station  on  Form  1971-E  or 
1971-F  accompanied  by  a  copy  of  the  request  upon  which  such  officer 
or  man  was  admitted.    They  will  be  furnished  treatment  at  stations 
of  the  first,  second,  and  third  class  only.    The  rate  of  charge  to  be 
made  for  the  care  and  treatment  of  the  said  officers  and  men  will  be 
fixed  by  the  department  at  the  beginning  of  each  fiscal  year,  and  will 
be  announced  to  officers  and  others  in  a  circular  letter  to  be  issued  by 
the  Surgeon  General. 

FOREIGN    SEAMEN. 

514.  The  accommodations  provided  for  the  care  and  treatment 
of  the  patients  of  the  Public  Health  Service  are  also  available  to 
foreign  seamen  at  relief  stations  of  the  first,  second,  and  third  class 
upon  the  application  of  the  consular  officer  of  the  nation  under 
whose  flag  they  are  sailing  or  upon  the  application  of  the  masters  of 
the  vessels  upon  which  said  seamen  serve,  provided  satisfactory  writ- 
ten security  is  given  for  the  payment  of  the  expenses  of  such  care 
and  treatment,  at  rates  fixed  annually  by  the  department.     When 
treatment  is  furnished  a  foreign  seaman  the  usual  reports  will  be 
sent  to  the  district  supervisor  on  Form  1971-E  or  Form  1971-F. 

515.  A  bill  in  duplicate  must  be  rendered  by  the  officer  of  the  serv-  . 
ice  in  charge  for  the  care  of  each  foreign  seaman  or  other  patient 
admitted  (not  entitled  to  treatment  free),  said  bill  to  be  rendered 
upon  the  termination  of  treatment  in  each  case.    One  copy  of  this 
bill  shall  be  delivered  to  the  collector  of  customs,  who  shall  at  once 
collect  the  amount;  the  other  copy  shall  be  forwarded  by  the  officer 
rendering  the  bill  to  the  Surgeon  General,  but  this  shall  not  apply 
to  patients  admitted  for  care  and  treatment  in  accordance  with  para- 
graph 513,  both  copies  of  bill  covering  such  transaction  to  be  for- 
warded to  the  Surgeon  General. 

516.  Customs  officers  acting  as  agents  of  the  Public  Health  Service 
shall  collect  all  bills  when  rendered  by  the  proper  officer  of  the  Public 
Health  Service  in  accordance  with  paragraph  515,  notifying  the  com- 


79 

manding  officer  of  the  vessel  against  which  the  bill  is  rendered  of 
the  amount  of  the  bill,  and  when  paid  will  give  a  receipt  therefor, 
and  will  render  monthly  accounts  for  all  moneys  collected  on  ac- 
count of  the  care  and  treatment  of  such  patients,  said  accounts  to 
be  accompanied  by  abstracts  giving  the  name  and  nationality  of 
the  patients,  date  of  admission,  and  date  of  discharge,  period  of 
treatment,  and  amount  collected  in  each  case. 

517.  The  rate  of  charge  to  be  made  for  the  care  and  treatment  of 
foreign  seamen  at  all  Public  Health  Service  and  marine  hospitals 
will  be  fixed  by  the  department  at  the  beginning  of  each  fiscal  year 
and  will  be  announced  to  officers  and  others  in  a  circular  letter  to  be 
issiied  by  the  Surgeon  General.    At  hospitals  under  contract  with  the 
Public  Health  Service,  the  contract  rate  will  be  charged. 

BENEFICIARIES  OF  THE   FEDERAL  BOARD  FOR   VOCATIONAL  EDUCATION. 

518.  The  district  organization  of  the  Federal  Board  for  Vocational 
Education  corresponds  geographically  to  that  of  the  Public  Health 
Service  and  the  Bureau  of  War  Kisk  Insurance. 

519.  Correspondence  between  the  district  medical  officers  of  the 
Federal  Board  for  Vocational  Education  and  the  district  supervisors 
of  the  Public  Health  Service  should  be  direct.    All  questions  relating 
to  matters  previously  covered  by  instructions  from  the  Surgeon  Gen- 
eral and  the  Federal  Board  for  Vocational  Education  should  be 
settled  Between  the  district  medical  officers  and  district  supervisors 
without  reference  to  the  Federal  Board  or  to  the  Surgeon  General. 

520.  When  requested  by  the  district  medical  officer  of  the  Federal 
Board  for  Vocational  Education,  the  district  supervisor  shall  cause 
an  examination  to  be  made  of  any  actual  or  prospective  beneficiary 
of  the  Federal  Board  for  Vocational  Education,  and  shall  place  him, 
if  necessary,  in  a  hospital  for  observation  or  special  examination. 

521.  Upon  receipt  of  a  request  from  the  Federal  Board  for  Voca- 
tional Education  for  copies  of  reports  of  physical  examinations  made 
for'the  Bureau  of  War  Kisk  Insurance  or  for  the  Federal  Board  for 
Vocational  Education,  district  supervisors  shall  furnish  such  copies 
as  may  be  requested. 

522.  Reports  of  physical  examinations  for  the  use  of  the  Federal 
Board  must  contain  the  following  information: 

(a)  Whether  there  is  ;t  reasonable  presumption  that  the  applicant 
has  a  disability  due  or  traceable  to  his  military  service,  and  whether 
it  is  permanent  or  temporary. 

(b)  Whether  he  has  a   vocational  handicap  resulting  from  the 
disability. 

(c)  That  his    physical    and    mental    condition    renders   training 
feasible. 


80 

523.  If  reports  do  not  contain  sufficient  data,  the  district  medical 
officer  will  be  required  to  obtain  it,  and  on  his  request  the  district 
supervisor  will  render  a  new  or  supplementary  report,  supplying  the 
missing  data  if  possible. 

524.  When  the  district  medical  officer  desires  an  examination  of  an 
applicant  who  lives  at  a  distance  from  the  district  office,  he  will  send 
a  letter  to  the  applicant  directing  him  to  go  to  the  nearest  available 
Public  Health  Service  examiner.    This  letter  will  be  sent  to  the  dis- ' 
trict  supervisor,  who  will  indorse  the  same  and  mail  it  to  the  appli- 
cant. 

525.  The  district  supervisor  will  keep  the  district  medical  officer 
informed  of  the  names  and  addresses  of  all  persons  in  his  district 
engaged  in  the  examination  of  claimants  of  the  Bureau  of  War  Risk 
Insurance. 

526.  When  the  examination  of  a  claimant  is  desired  by  both  the 
Bureau  of  War  Risk  Insurance  and  the  Federal  Board  for  Vocational 
Education,  the  expenses  incident  to  such  examination,  including 
transportation  to  the  place  of  examination,  will  be  charged  to  the 
Bureau  of  War  Risk  Insurance. 

527.  If  an  examination  is  made  for  the  purposes  of  the  Federal 
Board  only,  all  expenses,  including  transportation,  will  be  paid  by 
the  Federal  Board  for  Vocational  Education. 

528.  District  medical  officers  will  issue  transportation  requests  to 
beneficiaries  of  the  Federal  Board  for  Vocational  Education.     In 
cases  of  emergency,  however,  such  requests  may  be  issued  by  the  dis- 
trict supervisors.    The  district  vocational  officer  will  supply  the  dis- 
trict supervisor  with  a  book  of  blank  transportation  requests  for 
this  purpose. 

529.  Clerical  work  connected  with  fees  for  examination  and  trans- 
portation requests  must  be  reduced  to  the  minimum.    All  bills  in- 
curred for  this  purpose  shall  be  sent  direct  to  the  district  medical 
officer. 

530.  The  Federal  Board  for  Vocational  Education  will  not  pay 
bills  incurred  for  X-ray  examination  of  the  chest  in  cases  of  tuber- 
culosis, except  when  specially  authorized  by  the  district  vocational 
officer. 

531.  Disabled  men  discharged  from  the  military  or  naval  forces 
who  have  entered  upon  and  are  undergoing  a  course  for  vocational 
training  are  entitled  to  treatment  at  all  United  States  Public  Health 
Service  and  marine  hospitals,  contract  hospitals,  and  relief  stations 
of  the  service.    Treatment  in  each  instance  is  to  be  furnished,  so  far 
as  facilities  are  available,  upon  the  request  of  the  district  officers  of 
the  Federal  Board  for  Vocational  Education,  who  are  authorized 
to  use  for  this  purpose  the  Admission  Card  (Form  1971-D).    This 


81 

card  will  be  given  to  the  patient,  who  will  be  directed*  to  present  it 
to  the  designated  hospital  or  relief  station.  In  using  these  cards 
the  Federal  Board  officer  will  strike  out  the  words  "  for  examination 
only,"  will  insert  under  "  Class  "  the  letters,  "  F.  B.  V.  E.,"  and  will 
sign  over  his  official  title. 

532.  The  following  distinction  must  be  made  between  war-risk 
beneficiaries  and  beneficiaries  of  the  Federal  Board  for  Vocational 
Education:   Discharged  men  from  the  military   forces,  who  have 
entered  upon  and  are  undergoing  a  course  for  vocational  training, 
are  entitled  to  treatment  as  beneficiaries  of  the  Bureau  of  War  Risk 
Insurance  for  any  injury  or  disease  contracted  in  the  military  service 
prior  to  discharge,  or  for  which  they  have  previously  received  treat- 
ment while  in  the  military  service,  or  if  the  present  disability  can 
reasonably  be  connected  with  a  former  injury  or  disease  incurred  in 
the  military  service  prior  to  discharge.    Bills  for  treatment  of  these 
men  shall  be  rendered  to  the  Bureau  of  Public  Health  Service,  even 
though  they  were  received  or  treatment  was  given  at  the  request  of 
the  Federal  Board  for  Vocational  Education.    If  beneficiaries  of  the 
Bureau  of  War  Risk  Insurance,  however,  are  in  need  of  treatment  for 
any  injury  or  disease  which  is  in  no  way  connected  with  their  military 
service  they  may  receive  such  treatment  at  all  relief  stations  of  the 
Public  Health  Service  at  the  expense  of  the  Federal  Board  for  Voca- 
tional Education,  and  separate  vouchers  headed  "  Federal  Board  for 
Vocational  Education  "  shall  be  rendered  for  the  care  of  such  patients 
for  payment  by  the  Federal  Board  for  Vocational  Education  as  here- 
inafter provided.    Transportation  to  and  from  a  hospital  when  nec- 
essary for  such  cases  will  be  furnished  by  the  Federal  Board  for  Voca- 
tional Education. 

533.  At  stations  of  the  first  class  a  per  diem  charge,  as  announced 
by  the  Surgeon  General,  shall  be  made  for  each  in-patient  bene- 
ficiary of  the  Federal  Board  for  Vocational  Education  and  repay- 
ment   accounts    on    Form    1928    shall    be    prepared    in    duplicate, 
the  copy  to  be  forwarded  direct  to  the  Surgeon  General  and  the 
original  sent  to  the  district  supervisor  for  submittal  to  the  district 
medical  officer  of  the  board  for  examination  and  certification.     Fol- 
lowing the  approval  of  the  district  medical  officer,  vouchers  will  be 
prepared  by  the  district  vocational  officer  for  transfer  settlement 
from   the  "  Vocational   rehabilitation   appropriation "   to   that   for 
"  Care  of  seamen,  etc.,"  or  "  Pay  of  Personnel  and  Maintenance  of 
Hospitals,  P.  H.  S."     These  vouchers,  together  with  the  original 
Form  1928,  will  be  forwarded  by  the  district  vocational  officer  to 
the  Surgeon  General,  attention  relief  section.     Charges  covered  by 
repayment  accounts,  Form  1928,  should  be  taken  up  on  the  Monthly 

185279°— 20 6 


Eeport  ef  Belief  Furnished  Foreign  Seamen  and  Other  Pay  Patients, 
Form  1927. 

534.  A  charge  of  $1  per  treatment  shall  be  made  for  each  out- 
patient beneficiary  of  the  Federal  Board  for  Vocational  Educa- 
tion.   Eepayment  accounts  covering  such  treatment  should  be  ren- 
dered on  Form  1929  as  provided  for  in-patients  in  paragraph  533 
and  taken  up  on  the  Monthly  Eeport  of  Belief  Furnished  Foreign 
Seamen  and  Other  Pay  Patients,  Form  1927. 

535.  At  places  where  the  service  has  a  contract,  the  per  diem  charge 
for  in-patient  beneficiaries  of  the  Federal  Board  for  Vocational  Edu- 
cation shall  be  the  contract  rate. 

536.  Original  bills  from  contract  hospitals  shall  be  examined  by 
the  representative  of  the  Public  Health  Service  and  if  he  finds  that 
the  bills  were  incurred  according  to  regulations,  that  the  charges 
are  reasonable,  and  that  services  rendered  were  satisfactory,  he  shall 
stamp  the  bill — 

Approved: , 192 — . 


,  Surgeon,  U.  S.  P.  H.  S. 

537.  All  such  bills  should  then  be  forwarded  through  the  district  su- 
pervisor to  the  district  medical  officer  for  direct  payment  by  the  Fed- 
eral Board.    The  bills  must  be  accompanied  by  the  original  or  a  true 
copy  of  the  request  for  treatment  in  each  case.    Only  one  request  is 
necessary,  regardless  of  the  length  of  time  a  patient  remains  under 
treatment.     Bills  should  be  rendered  promptly  at  the  end  of  each 
month.     Such  bills  should  include  not  only  charges  for  hospital 
care  and  treatment  but  miscellaneous  service  under  contract,  such 
as  ambulance  and  X-ray  service,  use  of  operating  room,  etc.     Ex- 
penditures covered  by  such  bills  should  not  be  taken  up  on  the 
Monthly  Eeport  of  Belief  Furnished  Foreign  Seamen  and  Other 
Pay  Patients,  Form  1927,  and  Monthly  Schedule  of  Encumbrances, 
Form  1955. 

538.  Expenditures  incurred  by  stations  of  the  first  class  for  articles 
of  service  under  contract,  such  as  X-ray  or  ambulance  service,  will 
be  handleel  in  the  same  manner  as  specified  in  the  foregoing  para- 
graph. 

539.  Differences  of  opinion  between  the  Federal  Board  and  the 
Public  Health  Service,  involving  the  character  of  the  patient's  con- 
dition with  respect  to  the  expense  of  medical  care  in  any  particular 
case,  shall  be  determined  whenever  possible  by  conference  between 
the  district  vocational  officer  or  the  district  medical  officer  of  the 
Federal  Board  for  Vocational  Education  and  the  district  supervisor 
of  the  Public  Health  Service. 


83 

540.  Before  the  discharge  of  a  patient  from  a  hospital  the  medical 
officer  in  charge  will  notify  the  district  vocational  officer  a  sufficient 
time  in  advance  of  the  contemplated  discharge  to  provide  for  proper 
disposition  of  the  patient. 

541.  Upon  receipt  of  a  survey  from  a  representative  of  the  Federal 
Board  for  Vocational  Education,  indicating  the  educational  fitness  ef 
a  patient  to  receive  such  training  as  he  may  desire,  the  medical  officer 
in  charge  will  cause  an  examination  to  be  made  of  the  patient  to  de- 
termine his  physical  and  mental  condition.    After  the  findings  of  the 
examination  have  been  recorded  in  the  clinical  record,  the  survey  will 
be  returned  by  indorsement  to  the  representative  of  the  Federal 
Board  for  Vocational  Education,  with  a  recommendation  as  to  the 
general  character  and  daily  hours  of  work  to  be  undertaken  by  the 
patient.    If  a  patient  able  to  undertake  training  is  ambulant  and 
otherwise  fitted  to  assume  the  status  "  On  pass  "  for  a  limited  period, 
Form  1946-L  shall  be  completed  and  indorsed  "To  the  Federal 
Board  for  Vocational  Education  "  and  sent  to  the  medical  officer  with 
the  survey. 

542.  Form  1946-L  shall  be  completed  as  above  directed  and  for- 
warded to  the  training  officer  on  the  first  of  each  month  thereafter, 
and  no  patient  of  a  Public  Health  Service  hospital  may  be  given 
vocational  training  under  the  Federal  Board  for  Vocational  Educa- 
tion, unless  this  form,  properly  completed  and  signed  by  the  medical 
officer,  for  the  current  month,  is  on  file  with  the  training  officer  hav- 
ing supervision  of  the  training. 

543.  The  training  officer  of  the  Federal  Board  for  Vocational  Edu- 
cation, to  whom  the  patient  is  assigned  for  training,  will  enter  the 
specific  kinds  of  work  in  which  the  patient  is  engaged  and  the  num- 
ber of  hours  employed  daily,  on  Form  1973-D  and  Form  1946-L. 
Form  1973-D  will  be  returned  to  the  medical  officer  at  the  close  of 
work  on  each  Saturday  and  Form  1973-  will  be  returned  to  the 
medical  officer  on  the  last  day  of  each  month,  as  directed  by  instruc- 
tions for  the  use  of  these  forms. 

544.  Patients  in  Public  Health  Service  hospitals  taking  vocational 
training  under  the  Federal  Board  for  Vocational  Education  remain 
under  the  jurisdiction   of   the   Public   Health    Service,   and   while 
actually  attending  classes  have  the  status  of  patients  "On  pass.'' 

545.  Each  patient  in  a  hospital  of  the  service,  who  is  receiving  voca- 
tional training  under  the  Federal  Board  for  Vocational  Education, 
will  be  observed  carefully  each  day,  and  if  the  physical  or  mental 
condition  is  in  any  way  impaired  by,  or  during  the  period  of,  such 
training,  the  training  will  be  discontinued  immediately,  and  the 
training  officer  notified  as  to  the  cause  and  probable  duration  of  the 


84 

absence  of  the  patient.  The  training  will  not  be  resumed  until,  in 
the  opinion  of  the  medical  officer,  the  physical  and  mental  condition 
of  the  patient  is  such  as  to  justify  continuance. 

ARTICLE  XII. 


OUTPATIENT   RELIEF. 

546.  Sick  and  disabled  patients  of  the  Public  Health  Service  whose 
diseases  or  injuries  are  of  such  a  nature  that  they  can  properly  be 
relieved  by  medicines,  dressings,  or  advice,  without  admission  to 
hospital,  shall  be  treated  as  outpatients  and  furnished  medicines, 
dressings,  surgical  appliances,  or  advice,  as  the  case  may  require. 

547.  Seamen  will  not  be  furnished  relief  at  their  own  home  except 
by  special  authority  from  the  Surgeon  General,  and  then  only  an 
allowance  for  medical  attendance  and  medicines  will  be  made  at 
rates  fixed  by  the  Treasury  Department. 

REGISTER  OF  OUT-PATIENTS. 

548.  At  all  places  where  examinations  and  out-patient  treatment  are 
conducted,  one  copy  of  Form  1971-E,  Out-patient  Report,  Record, 
and  Transfer  Card,  shall  be  executed  at  the  time  of  the  examination, 
so  far  as  available  data  will  permit,  whether  the  applicant  or  patient 
is  received  by  transfer  or  applies  for  original  examination.     The 
word  "  Report "  will  be  inserted  in  the  blank  space  in  the  heading. 
The  card  shall  be  immediately  forwarded  to  the  district  supervisor. 
Original  report  cards  shall  be  filled  out  for  all  patients  in  addition 
to  Form  1934-B  Report  of  Physical  Examination  required  for  bene- 
ficiaries of  the  Bureau  of  War  Risk  Insurance.     ' 

549.  Upon  completion  of  treatment,  transfer  at  a  later  time,  or 
other  final  disposition,  another  report  card  shall  be  executed,  the 
record  of  treatment  completed  on  the  reverse  side,  including  date  of 
first  treatment  or  examination  and  date  of  all  subsequent  treatments, 
the  word  "  Report "  inserted  in  the  heading,  and  the  completed  card 
immediately  forwarded  to  the  district  supervisor. 

550.  When  a  patient  receiving  out-patient  treatment  fails  to  re- 
appear within  30  days  from  date  of  last  treatment,  a  completed  re- 
port card  shall  be  executed  and  forwarded  to  the  district  supervisor. 
Should  the  patient  apply  for  treatment  at  a  later  time,  a  new  register 
number  will  be  assigned,  and  reports  will  be  prepared  as  for  original 
examination. 

551.  In  every  case  of  transfer  from  a  place  of  examination  or  out- 
patient treatment  to  another  out-patient  office  or  to  a  hospital,  a 


85 

transfer  card,  which  shall  be  a  copy  of  the  completed  report  card, 
shall  be  executed  and  the  word  "  Transfer  "  inserted  in  the  blank 

;  space  in  the  heading  of  the  card.  The  destination -will  be  stated 
under  "  Disposition,"  and  the  transfer  card  shall  be  mailed  to  the 

1  receiving  officer  at  the  out-patient  office  or  hospital  to  which  the  appli- 
cant or  patient  is  directed.  The  applicant  or  patient  will  be  furnished 

I  with  an  Admission  Card,  Form  1971-D,  which  he  will  be  directed  to 
present  to  the  admitting  officer.  If  the  services  of  an  attendant  are 

i  required,  the  transfer  card  will  not  be  mailed,  but  will  be  given  in- 
stead to  the  attendant  for  presentation  to  the  admitting  officer,  and 
in  such  cases  the  admission  card  will  not  be  required. 

5J>2.  Designated  examiners  of  the  Bureau  of  War  Risk  Insurance, 
in  addition  to  using  Form  1971-E  as  a  report  and  transfer  card,  may, 
if  they  so  desire,  keep  a  record  of  applicants  and  patients  as  herein- 
after described. 

553.  All  officers  conducting  examinations  in  out-patient  offices  shall 
execute  a  second  card  at  the  time  of  examination,  which  shall  be  pre- 
served as  a  permanent  record  at  the  place  of  examination  or  treat- 
ment, the  word  "  Record "  will  be  inserted  in  the  heading  of  the 
card,  and  the  treatment  recorded  from  time  to  time  on  the  reverse 
side.    Record  cards  shall  be  kept  in  two  files:  (1)  The  current  file 
will  consist  of  the  cards  of  incomplete  cases,  arranged  in  alphabeti- 
cal order  according  to  the  surnames  of  the  patients;  (2)  the  perma- 
nent file  will  consist  of  cards  of  completed  cases,  arranged  in  the 
serial  order  of  their  register  numbers.    Register  numbers  will  be  con- 
secutive and  continuous.    Upon  transfer  or  completion  of  treatment, 
the  completed  record  card  shall  be  placed  in  the  permanent  file.    If 
the  applicant  or  patient  is  examined  only,  or  is  transferred  or  other- 
wise finally  disposed  of  at  the  time  of  original  examination,  record 
cards  shall  be  placed  in  the  permanent  file  as  soon  as  examination  is 
completed. 

554.  A  card  index  to  the  record  shall  be  kept  on  Form  1971-G, 
Index  to  Register  of  Patients.    One  index  card  shall  be  kept  for  each 
individual  applicant  or  out-patient  for  whom  a  record  card  is  on  file. 
Index  cards  will  be  filed  in  alphabetical  order  according  to  the  sur- 
name of  the  applicant  or  out-patient.    When  a  record  card  is  to  be 
started  and  its  number  to  be  assigned,  the  index  shall  be  searched  for 
previous  record  of  the  applicant  or  patient.     If  an  index  card  is 
found,  the  new  number  will  be  entered  thereon,  and  the  register  num- 
ber of  the  last  previous  examination  or  treatment  wrill  be  noted  on 
the  new  record  card.  , 

555.  When  an  applicant  presents  himself  for  examination  or  out- 
patient treatment  and  states  that  lie  has  previously  received  exami- 
nation or  treatment  at  another  place,  a  copy  of  his  former  record  card 


86 

may  be  requested  by  mail  from  the  officer  who  furnished  the  treat- 
ment. Treatment,  however,  will  be  furnished  upon  presentation  by 
the  applicant  of  evidence  establishing  his  right  to  the  same,  pending 
the  arrival  of  the  record  card. 

556.  The  evidence  of  each  out-patient's  right  to  relief  will  be  re- 
corded by  all  persons  conducting  examination  or  treatment  under 
"authority"  in  Form  1971-E,  Eegister  of   Out-patients,  and  all 
papers  authorizing  treatment  will  be  filed. 

£  FOURTH-CLASS   STATIONS. 

557.  Whenever  an  application  for  relief  is  presented  at  a  station  of 
the  fourth  class,  the  proper  customs  officer  at  the  port  is  authorised 
and  directed  to  cause  out-patient  relief  (medicines,  etc.)  to  be  fur- 
nished in  accordance  with  paragraph  546,  or  to  request  authority 
from  the  district  supervisor  to  furnish  transportation  to  a  relief 
station  of  the  first  class. 

558.  One  dollar  wijl  be  allowed  physicians  (not  officers  of  the  Pub- 
lic Health  Service)  for  the  medical  examination  of  each  seaman  who 
is  referred  by  a  customs  officer  for  such  examination,  whether  ac- 
companied by  a  prescription  or  not,  unless  otherwise  previously 
directed  by  the  department  (by  the  terms  of  special  agreements  or 
contracts).    When  more  than  two  treatments  are  furnished  the  same 
seaman  in  one  month,  an  explanatory  statement  signed  by  the  cus- 
toms officer  in  charge  of  the  port  will  be  attached  to  the  phj'sician's 
bill  for  the  services.     Treatment  in  cases  of  emergency   only   is 
contemplated. 

559.  No  separate  compensation  or  allowance  will  be  made  for  the 
medical  examination  made  by  physicians  in  cases  where  the  appli- 
cants examined  are  placed  under  hospital  treatment  or  its  equiv- 
alent at  the  relief  station  where  the  examination  is  made  except  when 
treated  in  hospital  by  another  physician. 

560.  Unreasonable  charges  for  relief  furnished  in  emergency  cases 
will  not  be  allowed  by  the  department. 

561.  Foreign  seamen  or  employees  of  the  various  Government  serv- 
ices are  not  entitled  to  treatment  by  physicians  (not  officers  of  the 
Public  Health  Service)  at  stations  of  the  fourth  class. 

IN-PATIENT   RELIEF. 

562.  A  sick  or  disabled  patient  of  the  Public  Health  Service  shall 
be    admitted  to  hospital  only  in  cases  where  the  gravity  of  the  dis- 
ease or  injury  from  which  he  suffers  is  such  as  to  require  hospital 
treatment  in  the  opinion  of  a  medical  officer  or  other  authorized 
medical  representative  of  the  service.    This  is  not  to  be  construed  to 


87 

exclude  patients  admitted  for  examination  and  observation  only.  In 
case  of  doubt  as  to  the  gravity  of  the  disease  or  injury  the  patient 
should  be  temporarily  admitted. 

563.  Medical  officers  and  other  authorized  representatives  of  the 
Public  Health  Service  who  provide  for  the  admission  of  patients  to 
contract  hospitals  are  required  to  procure  the  discharge  of  such 
patients  promptly  upon  the  termination  of  the  necessary  hospital 
treatment. 

564.  Officers  shall  not  be  required  to  attend  sick  or  disabled  seamen 
on  board  vessels  or  to  visit  them  in  harbor  except  at  the  discretion 
of  the  officer  to  whom  the  application  is  made. 

565.  Form  1971-D,  Admission  Card,  will  be  given  to  each  patient 
for  presentation  to  the  admitting  officer  at  the  hospital  by  all  per- 
sons authorizing  hospital  treatment  of  patients  of  the  service. 

REGISTER    OF    IX-PATIEXTS. 

566.  At  stations  of  the  first  class  and  contract  hospitals  a  copy  of 
Form  1971-F,  In-patient  Report,  Record,  and  Transfer  Card  shall 
be  executed  immediately  upon  the  admission  of  a  patient  to  a  hos- 
pital.   The  word  "  report "  will  be  inserted  in  the  heading,  all  data 
available  at  the  time  recorded,  and  the  card  immediately  forwarded 
to  the  district  supervisors. 

567.  Upon  completion  of  the  case  by  transfer,  discharge,  or  death, 
a  completed  report  card  shall  be  executed,  the  word  "  report "  in- 
serted in  the  blank  space  provided  in  the  heading,  and  the  card 
immediately  forwarded  to  the  district  supervisor. 

568.  In  every  case  of  transfer  of  a  patient  from  one  hospital  to 
another  a  transfer  card,  which  shall  be  a  copy  of  the  completed 
report  card,  shall  be  executed  and  the  word  "transfer"  will  be  in- 
serted in  the  blank  space  in  the  heading  of  the  card.    The  destination 
will  be  stated  under  "  disposition "  and  the  transfer  card  shall  be 
mailed  to  the  receiving  officer  at  the  hospital  to  which  the  patient  is 
directed.     The  patient  will  be  furnished  with  Form  1971-D,  Hospital 
Admission  Card,  which  lie  will  be  directed  to  present  to  the  admit- 
ting  officer.      If   the   services   of   an    attendant    are    required,   the 
transfer  card  will  not  be  mailed  but  will  be  given  instead  to  the 
attendant   for  presentation  to  the   admitting   officer,   and   in   such 
cases  the  hospital  admission  card  will  not  be  required. 

569.  A  second  card  shall  be  prepared  at  the  time  of  admission  of  a 
patient  at  stations  of  the  first  class  and  contract  hospitals,  which 
shall  be  preserved  at  the  hospital  as  a  permanent  record.    The  word 
';  record  "  will  be  inserted  in  the  heading  of  the  card.    Record  cards 
shall  be  kept  in  two  files:  (1)  The  current  file  will  consist  of  cards 
of  uncompleted  cases  arranged  in  alphabetical  order  according  to  the 


surnames  of  the  patients;  (2)  the  permanent  file  will  consist  of  cards 
of  completed  cases  arranged  in  the  serial  order  of  their  register 
numbers.  Upon  transfer  or  completion  of  treatment  the  completed 
record  card  shall  be  placed  in  the  permanent  file. 

570.  A  card  index  to  the  record  shall  be  kept  on  Form  1971-G, 
Index  to  Register  of  Patients.     One  card  index  shall  be  kept  for 
each  individual  inpatient  for  whom  a  record  card  is  on  file.     The 
index  cards  will  be  filed  in  alphabetical  order  according  to  the 
surnames  of  the  patients.    A  separate  index,  a  separate  register,  and 
a  separate  series  of  register  numbers  shall  be  kept  for  inpatients  and 
outpatients  at  all  hospitals  where  both  classes  of  patients  are  treated. 
When  a  record  card  is  to  be  started  and  its  number  to  be  assigned, 
the  index  will  be  searched  for  previous  record  of  the  patient.    If  an 
index  card  is  found,  the  new  number  will  be  entered  thereon  and  the 
register  number  of  the  last  previous  treatment  will  be  noted  on  the 
new  record  card. 

571.  When  an  applicant  presents  himself  for  hospital  treatment 
and  states  that  he  has  previously  received  such  treatment  at  another 
place,  a  copy  of  his  former  record  card  may  be  requested  by  mail 
from  the  officer  who  furnished  the  treatment.    Treatment,  however, 
will  be  furnished  upon  presentation  by  the  applicant  of  evidence 
establishing  his  right  to  the  same  pending  arrival  of  the  record 
card. 

572.  When  a  patient  of  the  Public  Health  Service  makes  applica- 
tion for  admission  to  a  contract  hospital  after  the  office  is  closed  for 
the  day,  the  person  in  charge  of  the  contract  hospital  may  admit 
the  patient,  should  the  case  be  urgent,  and  on  the  following  day 
report  the  action  taken  and  present  the  evidence  of  the  patient's 
right  to  treatment  to  the  authorized  representative  of  the  Public 
Health  Service. 

573.  Whenever  a  patient  applies  at  a  fourth-class  station  for  hos- 
pital relief  and  in  the  opinion  of  the  customs  officer  it  is  a  case  re- 
quiring immediate  attention,  and  the  papers  presented  by  the  appli- 
cant show  him  to  be  entitled  to  relief,  a  competent  physician,  in  the 
absence  of  an  acting  assistant  surgeon,  shall  be  called  to  decide 
whether  hospital  relief  is  necessary,  and  if  so  advised,  and  the  patient 
is  not  in  a  condition  to  be  transferred  to  a  Public  Health  Service 
or  marine  hospital,  the  customs  officer  shall  make  suitable  arrange- 
ments for  the  care  and  treatment  of  the  patient,  and  report  imme- 
diately by  letter  to  the  district  supervisor,  giving  rates  charged  there- 
for.   In  all  such  cases  the  customs  officer  will  require  the  hospital  to 
forward  to  the  district  supervisor  Form  1971-F,  In-patient  Eeport 
Card,  upon  admission  and  discharge,  as  required  by  regulations. 

574.  Whenever  a  patient  of  the  Public  Health  Service  applies  to 
an  acting  assistant  surgeon  or  to  a  designated  examiner  of  the  Bureau 


89 

of  War  Risk  Insurance  for  hospital  relief  and  upon  examination  is 
found  to  require  hospital  treatment,  if  the  applicant  is  not  in  a 
condition  to  be  transferred  to  a  Public  Health  Service  or  marine  hos- 
pital, the  officer  or  examiner  shall  make  suitable  arrangements  for  the 
hospital  care  and  treatment  of  the  patient  at  the  prescribed  rates,  and 
shall  immediately  report  the  admission  by  letter  to  the  district  super- 
visor, giving  the  rate  charged.  In  all  such  cases  the  person  authoriz- 
ing such  treatment  shall  require  the  hospital  to  submit  to  the  district 
supervisor  Form  1971-F,  In.-pat.ient  Report  Card,  upon  admission 
and  discharge,  as  required  by  regulations. 

DENTAL  TREATMENT. 

575.  Patients  of  the  Public  Health  Service  entitled  to  relief  shall 
be  furnished  with  such  dental  treatment  as  may  be  necessary  by  com- 
missioned dental  officers  of  the  service.    Xo  precious  metals  shall  be 
used  for  purely  cosmetic  reasons. 

ARTICLE  XIII. 
PUBLIC  PROPERTY. 
GENERAL  PROVISIONS. 

576.  Accountability  and  responsibility  devolve  upon  any  person  to 
whom  public  property  is  intrusted  and  who  is  required  to  make  re- 
turns therefor.    Responsibility  without  accountability  devolves  upon 
one  to  whom  such  property  is  intrusted,  but  who  is  not  required  to 
make  returns  therefor.    An  accountable  officer  is  relieved  from  re- 
sponsibility for  property  for  which  he  holds  a  proper  memorandum 
receipt.    A  responsible  officer  is  not  relieved  from  responsibility  for 
public  property  for  which  he  has  given  memorandum  receipt  until  he 
lias  returned  the  property  to  the  accountable  officer  or  has  secured 
memorandum  receipt  from  a  successor,  or  until  he  has  otherwise  been 
relieved  by  the  operation  oj  regulations  or  orders. 

577.  The  officer  in  permanent  or  temporary  charge  of  a  station 
is  responsible  for  the  security  of  all  public  property  of  the  station, 
whether  in  use  or  in  store,  and  although  the  materiel  officer  or  other 
subordinate  officer  be  accountable,  the  officer  in  charge  is  nevertheless 
responsible  and  pecuniarily  liable  with  him  for  the  strict  observance 
of  the  regulations  in  regard  to  its  preservation,  use,  and  issue.     He 
will  take  care  that  all  storehouses  are  properly  safeguarded,  that 

'only  reliable  agents  are  emploj'ed,  and  only  trustworthy  men  are 
detailed  for  duty  in  them  or  in  connection  with  property. 

578.  In  preparing  requisitions,  invoices,  and  receipts  for  property, 
all  entries  will  be  made  in  alphabetical  order  under  two  classifica- 


90 

tions:  First,  all  drugs  and  chemicals;  second,  all  other  supplies  and 
equipment.  To  facilitate  the  handling  of  these  papers,  one  line  of 
writing  only  shall  be  placed  in  each  interlinear  space. 

579.  Property  belonging  to  the  United  States  shall  not  be  disposed 
of  at  private  sale.     When  authority  has  been  obtained  from  the 
Secretary  of  the  Treasury  to  dispose  of  such  property,  it  may  be  sold 
at  public  sale,  after  due  notice  by  advertisement  either  by  publica- 
tion in  newspapers  authorized  by  the  Secretary  of  the  Treasury  or 
by  posting  written  or  printed  notices  in  places  frequented  by  the 
public. 

580.  The  exchange  of  medicines  or  supplies  with  druggists  or  mer- 
chants is  prohibited. 

581.  In  type  A  and  B  hospitals  the  materiel  officer  shall  be  account- 
able for  all  service  property  at  the  station,  and  shall  be  responsible 
therefor  wyhile  the  property  may  be  in  his  possession,  thereby  reliev- 
ing the  medical  officer  in  charge  of  direct  accountability  and  re- 
sponsibility for  the  property  in  the  hospital.     The  medical  officer  in 
charge,  however,  in  his  capacity  as  senior  officer  in  charge  of  the  sta- 
tion, shall  have  supervision  of  •  the  activities  of  the  materiel  officer 
and  shall  be  responsible  with  him  for  £he  proper  observance  of  regu- 
lations in  regard  to  property. 

582.  In  type  C  hospitals  the  pharmacist  or  administrative  assist- 
ant assigned  as  chief  clerk  shall  have  charge  of  all  service  property 
at  the  station  and  shall  assume  the  other  duties  of  the  materiel  officer. 

583.  At  second  and  third  class  stations  the  medical  officer  in  charge 
shall  have  custody  of  all  property  belonging  to  the  service  and  will 
account  for  the  same  to  the  Surgeon  General. 

584.  At  stations  where  no  officer  of  the  Public  Health  Service  is  on 
duty,  the  proper  customs  officer  shall  have  custody  of  all  property 
belonging  to  the  service  and  will  account  for  the  same  to  the  Surgeon 
General. 

ARTICLE  XIV. 

RESPONSIBILITY  FOB  PROPERTY  IN  HOSPITALS. 

585.  The  service  property  required  to  equip  the  wards  and  various 
departments  of  hospitals  will  be  issued  by  the  materiel  officer  on 
requisition  approved  by  the  medical  officer  in  charge  to  officers  in 
immediate  charge  of  the  wards  and  departments  where  said  prop- 
erty is  to  be  used.     Such  requisition  shall  be  submitted  weekly  to  the 
materiel  officer  on  Form  1902-H,  Nonexpendable  Slip,  and  Form 
1902-E,  Expendable  Slip,  on  a  day  to  be  designated  by  the  medical' 
officer  in  charge.     All  officers  will  be  responsible  for  the  service  prop- 
erty issued  to  wards  or  departments  under  their  immediate  charge. 


91 

586.  At  the  end  of  the  month  the  materiel  officer  will  combine  the 
original  copies  of  memorandum  receipts  for  nonexpendable  property 
issued,  obtain  the  signature  of  the  responsible  officer  in  each  case 
upon  Form  1902-1,  Consolidated  Memorandum  Receipt  For  Nonex- 
pendable Property,  and  return  the  old  receipts  to  the  officer  concerned. 

587.  Upon  receipt  of  the  consolidated  memorandum  receipt  from 
the  materiel  officer,  officers  will  be  required  to  check  the  property 
enumerated  thereon  in  order  that  shortages  can  be  traced,  and  that 
proper  disposition  can  be  made  of  unserviceable  and  excess  prop- 
erty.    All  shortage  or  excess  must  be  reported  to  the  materiel  officer 
at  once.     Property  which  is  not  needed  for  immediate  use  must  be 
returned  to  the  material  officer. 

588.  In  addition  to  the  monthly  check  of  property  by  responsible 
officers  a  check  will  be  made  in  the  event  of  the  transfer  of  a  responsi- 
ble officer  from  a  ward  or  department.     No  officer  will  be  relieved  from 
his  responsibility  for  property  in  a  ward  or  department  until  a  re- 
ceipt from  his  successor  has  been  obtained  by  the  materiel  officer. 

589.  When  an  officer  is  assigned  as  ward  surgeon  or  in  immediate 
charge  of  a  department  he  will  obtain  from  his  predecessor  an  ac- 
curate list  of  all  nonexpendable  property  in  use  in  the  ward  or  de- 
partment, and  at  once  make  a  personal  check  of  the  same.     If  no 
shortage  is  discovered,  both  officers  will  report  to  the  materiel  officer 
where  a  transfer  of  responsibility  will  be  made.     The  officer  receiv- 
ing the  property  will  sign  the  new  consolidated  receipt  and  the  old 
receipts  will  be  returned  to  his  predecessor.     All  shortage  discovered 
will  be  recorded  and  the  officer  receiving  the  property  will  sign  only 
for  the  property  actually  present.     A   copy  of  all  memorandum 
receipts  to  the  materiel  officer  will  be  on  file  at  all  times  in  wards  or 
departments  concerned. 

590.  Officers   in  charge  of   wards  or  departments   must  exercise 
constant  vigilance  to  prevent  the  unauthorized  transfer  of  property 
for  which  they  are  responsible  to  other  wards  or  departments. 

591.  When  it  is  necessary  to  make  such  transfers  the  materiel  officer 
must  first  be  notified,  except  in  cases  of  extreme  emergency.     In  such 
event  the  action  taken  will  be  reported  to  the  materiel  officer  at  tho 
earliest  possible  moment. 

592.  Nurses  and  other  employees  of  the  hospital  will  be  responsible 
to  the  officer  who  has  signed  a  memorandum  receipt  for  the  property, 
for  the  care  and  proper  use  of  all  such  property  in  their  immediate 
possession. 

593.  Officers  will  exercise  constant  supervision  over  their  subordi- 
nates in  order  to  prevent  the  use  of  service  property  for  improper 
purposes.     This  applies  especially  to  the  misuse  of  blankets,  towels, 
and  sheets  for  polishing,  dusting,  scrubbing,  or  window  washing. 


92 
ARTICLE  XV. 

LOSS  OB  DESTRUCTION  OF  PROPERTY. 

594.  Causes  of  damages  to  and  loss  or  destruction  of  service  prop- 
erty may  be  classed  as  follows : 

(a)  Unavoidable  causes^  being  those  over  which  the  person  re- 
sponsible for  the  property  has  no  control,  occurring  in  the  ordinary 
course  of  service,  or  as  incident  to  unusual  emergency. 

(5)  Avoidable  causes  being  those  due  to  carelessness,  willfulness, 
or  neglect. 

595.  In  case  of  loss  or  destruction  of  nonexpendable  articles,  the 
officer  accountable  for  the  property  shall  investigate  the  loss  or  de- 
struction thereof  at  once,  and  report  the  same  to  the  medical  officer 
in  charge,  accompanied  by  the  affidavit  in  duplicate  of  the  responsible 
officer  or  employee.     If  the  evidence  is  considered  satisfactory  by 
the  medical  officer  in  charge,  the  responsible  officer  will  be  so  in- 
formed, and  both  copies  of  the  affidavit  will  be  forwarded  to  the 
Purveying  Depot,  attention  Property  Return  Section,  for  the  ap- 
proval of  the  Surgeon  General.    If  approved  by  the  Surgeon  Gen- 
eral, the  accountable  officer  will  be  authorized  to  drop  the  property 
from  his  return.     If  the  evidence  is  not  satisfactory,  the  Surgeon 
General  will  appoint,  or  authorize  the  medical  officer  in  charge  to 
appoint,  a  board  of  survey,  consisting  of  not  less  than  two  commis- 
sioned officers,  to  investigate  the  loss  or  destruction  of  the  property, 
the  report  of  said  board  to  include  recommendations  as  to  restitution 
in  such  amount  as  may  seem  to  be  just  or  practical,  or  both. 

ARTICLE  XVI. 

UNSERVICEABLE  PROPERTY. 

596.  The  medical  officer  in  charge  of  each  hospital  station  shall  set 
aside  a  suitable  room  for  the  reception  and  storing  of  property  turned 
over  to  the  accountable  officer  as  worn  out  or  unfit  for  use.    This 
room  shall  be  provided  with  shelving  and  compartments  for  the 
orderly  arrangement  of  such  property. 

597.  Form  1902-G  Exchange  Slip  will  be  used  by  responsible  offi- 
cers for  the  purpose  of  exchanging  property  which  has  become  un- 
serviceable through  the  ordinary  course  of  service.    The  responsible 
officer  will  present  such  property,  accompanied  by  the  exchange  slip, 
to  the  accountable  officer.     Articles  will  be  listed  on  this  form  in 
accordance  with  the  instructions  on  the  reverse  side,  and  if  in  the 
opinion  of  the  accountable  officer  the  property  has  been  rendered 
unserviceable  without  fault  or  neglect  upon  the  part  of  the  respon- 
sible officer,  new  articles  will  be  given  in  exchange;  othenvise  the 


93 

property  will  be  presented  to  the  medical  officer  in  charge  for  his  in- 
spection and  decision. 

598.  Articles  of  property  inspected  by  officers,  under  instructions 
from  the  Surgeon  General,  will  be  reported  upon  fully  as  to  their  con- 
dition, with  recommendations  for  -their  disposal.     Such  articles  as 
can  be  repaired  or  utilized  by  the  service  will  not  be  recommended 
to  be  sold  or  destroyed. 

599.  Care  of  such  property  and  the  preservation  of  same  pending 
the  action  of  an  inspector  is  required.     Articles  which  may  be  re- 
paired or  which  are  not  entirely  worn  out  must  be  suitably  protected 
from  the  effects  of  atmosphere,  vermin,  or  other  deteriorating  agen- 
cies after  deposit  in  such  room. 

600.  Accountable  officers  shall  forward  to  the  Surgeon  General, 
attention  Inspection  Division,  on  the  1st  day  of  January  and  1st  day 
of  July  of  each  year  an  inventory  of  all  articles  of  property  for 
which  they  are  accountable,  which  have  been  broken,  worn  out,  or 
otherwise  rendered  unfit  for  further  use,  and  all  such  articles  will  be 
retained  for  inspection.    The  last  report  shall  include  all  articles  pre- 
viously reported,  which  have  not  been  condemned. 

601.  Articles  of  hospital  bedding  and  clothing  will  be  made  up  into 
parcels  of  10,  properly  labeled,  and  broken  crockery  and  glassware 
restored  by  piece,  as  far  as  possible,  and  arranged  for  inspection  and 
count.    To  facilitate  the  work  of  condemnation,  all  articles  are  to 
be  so  placed  in  the  room  that  they  shall  follow  in  order  the  sequence 
of  the  list  as  presented  to  the  inspector. 

602.  All  articles  when  condemned  by  the  inspector  shall  be  sepa- 
rated into  two  lots  for  destruction  and  disposal,  viz,  articles  that  can 
be  destroyed  by  burning,  and  articles  that  are  indestructible  by  this 
means.      The    former   class   shall   be   immediately   burned    on   the 
premises  in  the  presence  of  the  inspector,  and  the  latter  class  shall  be 
immediately    carried    off    to    a    public    dumping    place    and    there 
deposited. 

€03.  The  inspector  is  authorized  to  except  from  the  above  provi- 
sion a  reasonable  quantity  of  articles  (sheets,  pillowcases,  towels, 
etc. )  for  use  in  cleaning  work  and  to  permit  the  retention  of  portions 
of  articles  that  may  be  useful  in  the  preservation  of  others  of  a  simi- 
lar character  or  suitable  for  repair  work  about  the  station. 

604.  The  officer  accountable  for  unserviceable  property  about  to  be 
condemned  will  accompany  the  inspector  during  such  examination 
and  give  him  all  necessary  information  as  to  its  use  and  present 
condition,  with  the  cause  thereof. 

605.  Public  property  in  use  shall  not  be  reported  as  unserviceable, 
nor  condemned  by  the  inspector,  merely  because  worn  or  shabby  in 
appearance,  if  the  same  be  still  serviceable. 


94 

606.  Xo  other  persons  than  those  designated  in  paragraph  602,  ex- 
cept the  Surgeon  General  and  the  Secretary  of  the  Treasury,  shall 
order  the  final  disposition  of  condemned  property,  unless  in  case  of 
live  stock,  which  may  be  immediately  killed  to  prevent  contagion 
or  suffering. 

607.  Articles  of  property  inspected  by  officers,  under  instructions 
from  the  Surgeon  General,  will  be1  reported  upon  fully  as  to  their 
condition,  with  recommendations  for  their  disposal.     Such  articles 
as  can  be  repaired  or  utilized  by  the  service  will  not  be  recommended 
to  be  sold  or  destroyed. 

608.  Reports  of  the  inspection  of  unserviceable  property  shall  be 
given  the  proper  voucher  number  as  required  by  paragraph  617  and 
forwarded  in  duplicate  to  the  Purveying  Depot,  attention  Property 
Return  Section,  for  the  approval  of  the  Surgeon  General. 

609.  Unserviceable  property  which  has  once  been  condemned  shall 
not  again  be  submitted  for  inspection. 

610.  Public  property  which  has  been  condemned  and  is  offered  for 
sale  by  authority  of  the  department  shall  not  be  purchased  by  the 
officer  who  was  responsible  therefor  at  the  time  of  condemnation, 
nor  by  any  officer  or  attendant  who  bore  any  part  in  such  condemna- 
tions. 

811.  Receipts  accruing  from  the  proceeds  of  sale  of  condemned  and 
surplus  property  belonging  to  the  Public  Health  Service  shall  be 
deposited  as  "  Miscellaneous  receipts." 

ARTICLE  XVII. 
ACCOUNTABILITY   FOR  PROPERTY. 

612.  All  officers  accountable  for  public  property  will  take  up  on 
their  property  returns  and  account  for  all  property  of  the  service, 
expendable  and  nonexpendable,  which  comes  into  their  possession. 
If  it  is  property  with  which  they  have  not  been  formerly  charged,  as 
property  found  at  station,  they  will  report,  if  possible,  to  whose 
account  it  should  be  credited.     Expendable  property  will  be  dropped 
from  the  property  return  on  Form  9203-C  as  directed  under  "  Prop- 
erty returns." 

613.  Xo  property  will  be  accounted  for  as  on  hand  at  the  end  of  the 
accounting  period  unless  the  same  is  then  in  fact  on  hand. 

614.  Xo  property  will  be  dropped  from  the  property  return  with- 
out authority  from  the  Surgeon  General  except  such  articles  as  are 
declared  to  be  expendable  by  the  Surgeon  General.     Lists  of  such 
articles  will  be  issued  by  the  Surgeon  General  from  time  to  time. 

615.  All  books,  such  as  lists  of  merchant  vessels,  city  directories, 
nomenclature  of  diseases,  and  other  publications,  the  dates  of  which 


95 

render  them  useless  after  the  year  for  which  they  are  intended,  may 
be  dropped  from  the  return. 

PROPERTY  RETURNS. 

616.  All  accountable  officers  will  render  a  property  return  semi- 
annually,  on  December  31  and  June  30,  of  all  property  received,  issued, 
and  remaining  on  hand  during  the  period.    The  original  return  shall 
be  forwarded  promptly  to  the  Purveying  Depot,  attention  Property 
Return  Section,  and  the  duplicate  return  filed  at  the  station,  together 
with  the  retained  vouchers  pertaining  thereto. 

617.  All  invoices,  receipts,  lists  of  property  received  by  purchase, 
lists  of  property  expended,  lists  of  property  found  at  station  and 
taken  up  on  the  property  return,  approved  inventory,  and  inspection 
reports  will  be  considered  as  vouchers  to  the  property  return.    All 
vouchers  will  be  numbered  serially,  beginning  with  number  1  for  the 
first  voucher  of  the  period.    As  vouchers  are  received  or  prepared 
and  forwarded  they  shall  be  immediately  entered  on  the  property 
return  and  the  balance  cast.    At  the  end  of  the  accounting  period  it 
will  be  necessary  only  to  total  the  columns  and  number  the  slips  in 
order  to  close  the  return.     To  open  the  new  property  return,  slips 
for  all  property  remaining  on  hand  shall  be  written  and  the  balance 
remaining  oil  hand  from  the  old  return  carried  forward  to  the  "on 
hand  last  return  "  column  of  corresponding  new  slips.    The  vouchers 
to  the  new  return  will  be  numbered  serially,  beginning  again  with 
number  1. 

618.  The  number  given  a  voucher  at  the  station  of  its  origin  bears 
no  relation  to  the  number  to  be  given  it  at  the  station  receiving  same ; 
for  instance,  the  purveying  depot's  invoice  for  a  shipment  may  bear 
the  number  912,  Avhile  the  corresponding  receipt  may  be  the  fourth 
voucher  to  the  property  return  of  the  receiving  station,  and  would, 
therefore,  be  numbered  4. 

6J9.  At  the  end  of  each  month  the  accountable  officer  shall  list  in 
alphabetical  order  on  Form  9203-C,  first,  all  alcoholics  and  narcotics; 
second,  all  other  drugs  and  chemicals;  third,  all  other  expendable 
property  issued  from  the  storeroom  during  the  month.  This  voucher 
shall  be  prepared  and  signed  in  duplicate,  the  voucher  number  and 
date  entered,  and  the  original  copy  forwarded  promptly  to  the  Pur- 
veying Depot,  attention  Property  Return  Section.  The  duplicate  copy 
shall  be  filed  with  the  retained  property  vouchers  after  the  proper 
credits  have  been  made  on  the  property  return. 

620.  At  the  end  of  the  semiannual  accounting  period  all  expendable 
property  issued  during  the  period  shall  be  listed  alphabetically  on 
Form  9203-C  and  the  same  disposition  made  of  this  voucher  as  di- 
rected in  the  preceding  paragraph.  This  voucher  shall  be  the  last 


96 

voucher  of  the  series  of  the  semiannual  return,  and  after  the  credits 
claimed  thereon  have  been  entered  on  the  property  return  the  quan- 
tities shown  in  the  "  Balance  "  column  shall  agree  with  the  stock  on 
hand  in  the  storeroom. 

621.  Before  the  property  return  is  closed  an  actual  count  of  stock 
in  the  storeroom  shall  be  made,  and  the  quantities  on  hand  in  the 
storeroom  plus  the  quantities  shown  on  memorandum  receipt  as  in  use 
at  the  station  shall  agree  with  the  total  shown  on  the  property  return 
as  remaining  on  hand. 

TRANSFER  OF  PROPERTY   BETWEEN   ACCOUNTABLE   OFFICERS. 

622.  In  ordinary  transfer  of  supplies  and  equipment  between  ac- 
countable  officers,  the  transferring  officer  should   list   all   articles 
transferred  on  Form  9203-A  or  9203-B,  in  quintuplicate,  enter  his 
voucher  number  on  all  copies,  sign  the  first  two  as  invoices,  imme- 
diately forward  the  first  copy  to  the  Purveying  Depot,  attention 
Property  Return  Section,  the  second,  third,  and  fourth  copies  direct 
to  the  receiving  officer,  the  fifth  copy  to  be  retained  until  the  arrival 
of  the  receipt  from  the  receiving  officer,  then  destroyed,  and  the  re- 
ceipt posted  on  his  property  return  and  filed.    The  receiving  officer 
shall,  upon  receipt  of  the  supplies,  promptly  check  same  with  the  in- 
voice, enter  the  date  and  his  voucher  number  on  the  invoice  and  two 
receipts,  sign  the  receipts  and  forward  one  to  the  Purveying  Depot, 
attention  Property  Return  Section,  and  the  other  direct  to  the  trans- 
ferring officer.    The  invoice  shall  be  posted  on  his  property  return 
and  filed.     A  packer's  list,  if  necessary,  will  be  furnished  by  the 
transferring  officer  immediately  upon  shipment  of  supplies. 

623.  Great  care  shall  be  exercised  before  receipting  for  cases  of 
instruments,  microscopes,  and  other  property  of  similar  character 
not  enumerated  on  the  property  papers  in  detail,  to  ascertain  that 
the  full  contents  of  such  cases  are  present  and  in  good  order.     In- 
complete cases  shall  be  receipted  for  as  such  and  a  list  of  the  miss- 
ing articles  shall  accompany  the  receipt,  in  order  that  the  proper 
officer  may  be  held  accountable  for  the  deficiency.     Receipts  with- 
out remarks  for  cases  of  instruments  and  similar  property  will  be 
considered  as  evidence  that  they  are  complete,  and  the  receiving 
officer  will  be  held  accountable  in  accordance  therewith. 

624.  The  transferring  officer  shall  enter  on  his  invoices,  and  the 
receiving  officer  on  his  receipts,  the  condition  of  all  articles  not 
serviceable.     The  maker's  serial  number  of  all  microscopes,  type- 
writers, safes,  motor  vehicles,  and  similar  property  shall  be  entered 
on  all  invoices  and  receipts. 

625.  In  cases  in  which  complete  transfer  of  medical  property  oc- 
curs the  receiving  officer,  instead  of  giving  separate  receipts,  shall 


97 

receipt  for  the  property  transferred  on  the  final  return,  both  origi- 
nal and  duplicate  (Form  1903-D),  of  his  predecessor.  The  trans- 
ferring officer  shall  forward  the  original  return  promptly  to  the  Pur- 
veying Depot,  Attention  Property  Eeturn  Section.  The  duplicate 
return  will  be  filed  with  the  retained  records  of  the  hospital. 

626.  Whenever  property  is  taken  over  by  a  representative  of  the 
service  from  any  department  of  the  Government  or  any  other  sources, 
inventories  shall  be  made  in  quadruplicate  fully  describing  the  prop- 
erty and  condition  of  same.    Three  copies  of  this  inventory  shall  be 
dated,  signed,  and  forwarded  promptly  to  the  Purveying  Depot,  at- 
tention Property  Return  Section. 

ARTICLE  XVIII. 
REQUISITIONS  FOB  PROPERTY. 

627.  Requisitions  for  medical,  surgical,  and  other  supplies  shall  bo 
forwarded   semiannually,   in    duplicate,   to   the   medical   purveyor, 
United  States  Public  Health  Service,  Washington,  D.  C.     In  order 
to  expedite  the  filling  of  semiannual  requisitions,  they  shall  be  for- 
warded from  the  various  stations  as  follows : 


From  stations  in  district — Continued. 

No.  8 November  1  and  May  1. 

No.  9 October  15  and  April  15. 

No.  10__July  15  and  January  15. 
No.  11 — August  15  and  February  15. 
No.  12— August  15  and  February  15. 
No.  13__October  15  and  April  15. 
No.  14__November  15  and  May  15. 


From  stations  in  district — • 

No.  1 July  1  and  January  1. 

No.  2 August  1  and  February  1. 

No.  3 December  15  and  June  15. 

No.  4 September  1  and  March  1. 

No.  5— October  1  and  April  1. 
No.  6___December  1  and  June  1. 
No.  7___ September  15  and  March  15. 

628.  The  standard  as  to  articles  and  quantities  allowed  to  stations 
shall  be  the  Official  Supply  Table  of  the  United  States  Public  Health 
Service.     No  remark  shall  be  made  opposite  the  name  of  any  article 
that  a  special  kind  or  a  special  make  or  pattern  is  wanted,  as  the 
semiannual  requisition  is  intended  to  include  only  such  articles  as 
are  kept  on  hand  in  the  purveying  depot  for  issue,  and  not  such  as 
have  to  be  specially  purchased;  the  latter  when  wanted  should  be 
asked  for  on  special  requisition.     Only  such  quantities  should  be 
asked  for  as  will  probably  be  needed  during  the  six  months'  period, 
computed  on  the  basis  of  original  packages.    Fractional  parts  of  a 
bottle  or  package  should  not  be  asked  for.    The  quantities  asked  for, 
plus  the  quantities  on  hand,  should  not  exceed  those  specified  in  the 
supply  table  as  the  allowance  for  the  station. 

629.  When,  as  a  result  of  the  prevalence  of  an  epidemic  or  for  any 
other  reason,  necessary  supplies  are  likely  to  be  exhausted  before  the 
next  semiannual  requisition  is  to  be  made,  they  shall  be  called  for  on 

185279°— 20 7 


98 

a  special  requisition,  with  a  full  explanation  of  the  emergency  and  its 
cause.  ITT  extreme  cases  telegraphic  application  shall  be  made  direct 
to  the  medical  purveyor  for  the  supplies  needed  to  meet  the  emer- 
gency, which  shall  be  followed  by  a  letter  of  explanation.  Officers 
in  charge  will  be  held  accountable  for  any  suffering  which  may  result 
from  their  failure  to  requisition  for  supplies  when  it  is  evident  the 
same  will  be  needed.  The  frequent  rendition  of  special  requisitions 
would  usually  argue  a  want  of  reasonable  foresight  in  asking  for 
supplies,  or  a  want  of  proper  economy  in  the  use  of  hospital  property 
and  would  be  a  reproach  to  medical  administration.  If  due  care  in 
the  use  of  hospital  property  is  exercised,  and  the  regulations  herein 
made  for  the  timely  preparation  of  semiannual  requisitions  are  ob- 
served, it  will  seldom  be  necessary  to  resort  to  the  special  or  tele- 
graphic requisition. 

630.  The  local  prevalence  or  rarity  of  certain  diseases,  as  well  as 
the  quantity  or  number  of  each  article  on  hand,  will  be  considered  in 
the   preparation   and   approval  of  semiannual  requisitions.     The> 
smaller  stations  will  not  need  all  of  the  articles  included  in  the  supply 
table.    The  officer  preparing  the  requisition  is  not  expected  to  ask  for 
an  article  merely  because  it  is  listed/  He  shall  call  for  only  what  there 
is  reason  to  think  he  will  need. 

631.  Officers  in  charge  and  materiel  officers  shall,  so  far  as  practi- 
cable, anticipate  the  needs  of  the  service  at  their  respective  stations 
by  making  requisition  for  such  articles  of  hospital  equipment,  bed- 
ding, clothing,  and  medical  supplies,  or  other  property,  as  may  be 
necessary  to  anticipate  the  probable  needs  of  the  station  for  a  period 
of  six  months. 

632.  Requisitions  for  articles  of  hospital  equipment  must  not  be 
made  in  anticipation  of  needs  beyond  a  period  of  six  months  with  a 
view  to  accumulate  a  surplus  stock  in  excess  of  probable  loss  by  break- 
age or  wear. 

STATIONERY  AND  BLANK  FORMS. 

633.  Requisitions  for  stationery  will  be  made  quarterly,  on  Janu- 
ary 1,  April  1,  July  1,  and  October  1.    All  instructions  on  the  requisi- 
tion blank  must  be  carefully  observed  and  requisitions  must  be  sub- 
mitted in  duplicate  on  the  proper  form.    When  stationery  articles 
not  listed  on  the  requisition  blank  are  needed,  stationery  articles 
listed  under  class  1  of  the  General  Schedule  of  Supplies  can  be  in- 
serted, giving  the  item  number  and  all  necessary  details.     Requisi- 
tions for  blanks  and  blank  books  will  be  made  quarterly,  on  January 
1,  April  1,  July  1,  and  October  1.    All  instructions  on  the  requisition 
blank  must  be  carefully  observed  and  requisitions  must  be  submitted 
in  duplicate  on  the  proper  form. 


99 

634.  Officers  will  give  personal  attention  to  requisitions  for  sta- 
tionery and  blanks,  to  see  that  excessive  amounts  are  not  asked  for 
and  that  only  enough  supplies  to  last  until  the  time  for  making  the 
next  requisitions  are  requested.     The  invoices  for  stationery   and 
blanks  received  must  be  promptly  signed  and  immediately  forwarded 
to  the  Surgeon  General.    Requisitions  and  all  correspondence  regard- 
ing stationery  and  blanks  must  be  addressed  to  the  Surgeon  General. 
When  supplies  are  required  to  be  replenished  at  any  time  between  the 
dales  for  making  regular  requisitions,  supplementary  requisitions 
may  be  forwarded,  listing  only  the  articles  and  quantities  required  up 
to  the  time  of  the  next  quarterly  requisitions,  stating  the  reason  which 
necessitates  the  request.     A  small  reserve  stock  should  be  kept  on 
hand  at  all  times,  so  that  if  there  should  be  delays  in  obtaining  sup-- 
plies asked  for  on  requisitions,  the  work  at  the  station  will  not  be 
inconvenienced.     On  the  other  hand,  there  should  not  be  a  large  ac- 
cumulation of  blank  forms,  etc.,  as  when  changes  are  made  in  any 
forms  the  old  stock  becomes  obsolete  and  there  results  a  waste  of  sup- 
plies.    The  samples  of  letterheads  and  envelopes,  or  other  matter, 
requiring  special  printing,  must  be  carefully  prepared  and  submitted 
in  duplicate  with  the  requisitions,  showing  exact  copy  of  printing  de- 
sired.    Whenever  it  is  desired  to  institute  a  new  form,  the  matter 
should  be  submitted  to  the  bureau,  giving  all  reasons  and  data  regard- 
ing the  form  and  the  object  sought  to  be  accomplished.    Under  the 
law  all  printing^  must  be  furnished  through  the  Government  Printing 
Office  in  Washington,  D.  C. 

ARTICLE  XIX. 

SPECIAL  REQUISITIONS   AND   PURCHASES. 

635.  When  supplies  or  articles  not  listed  in  the  supply  table  are 
required,  special  requisition  should  be  prepared  and  forwarded  in 
duplicate  to  the  medical  purveyor,  United  States  Public  Health  Serv- 
ice, Washington,  D.  C.,  with  explanation  of  the  necessity  for  the 
reqifest.    To  avoid  delay  in  filling  these  requisitions  a  full  descrip- 
tion of  the  articles,  as  to  dimensions,  type,  pattern,  quality,  or  num- 
ber shall  be  given,  together  with  a  statement  of  their  cost  or  approxi- 
mate cost,  as  ascertained  from  dealers'  catalogues  or  other  reliable 
sources  of  information,  in  appropriate  columns,  properly  totaled. 

636.  Special  requisitions  for  furniture,  rugs,  etc.,  required  for  the 
quarters  of  officers,  nurses,  dietitians,  aides,  and  other  employees, 
shall  show  separately  the  quantities  required  for  each  class  of  quar- 
ters, the  style,  color,  and  finish  of  furniture  it  is  intended  to  match, 
if  any,  and  the  rooms  it  is  intended  for:  Recreation,  office,  library, 
living,  dining,  and  bed  rooms.    In  asking  for  rugs  the  floor  dimen- 
sions of  the  room  as  well  as  the  size  of  the  rug  shall  be  given. 


100 

637.  Special  requisitions  should  be  made  for  articles  which  are  not 
on  contract  and  can  be  purchased  advantageously  at  the  station.    If 
the  need  of  the  articles  is  urgent,  proposals  taken  by  poster  and  cir- 
cular letter  advertisement  should  be  forwarded  with  a  special  requi- 
sition for  approval  by  the  Surgeon  General  or  the  Secretary  of  the 
Treasury.    The  law  requires  that  proposals  be  solicited  from  at  least 
two  responsible  dealers.    When  only  one  proposal  is  forwarded,  the 
failure  to  secure  competitive  proposals  should  be  explained. 

638.  The  several  columns  in  special  requisitions  should  be  filled  out 
in  respect  to  each  item  listed.    The  estimated  price  shall  be  given 
in  each  case  when  practicable  to  obtain  it  from  dealers.     In  case 
of  new  or  unusual  supplies  and  equipment  involving  considerable 
expense  the  explanatory  letter  should  describe  in  detail  the  supplies  or 
equipment  desired,  and  submit  adequate  reasons  for  their  purchase. 

639.  The  subject  of  repairs  to  property  of  the  service  shall  form 
the  basis  of  separate  communications  to  the  Surgeon  General,  and  in 
all  cases  must  be  accompanied  with  estimates  of  the  probable  cost 
of  same. 

640.  All  shipments  shall  be  made  on  Government  bill  of  lading 
and  instructions  on  same  should  be  closely  followed.    The  freight 
charges  shall  not  be  prepaid  and  are  not  to  be  paid  by  the  consignee, 
who  should  sign  the  bill  of  lading  in  proper  form  and  deliver  it  to 
the  last  carrier. 

641.  When  authorized  purchases  of  property  are  made  at  a  station, 
two  copies  of  Form  9202-B,  invoice  of  property  received  by  purchase, 
shall  be  prepared  at  the  time  of  preparing  the  public  voucher ;  said 
invoice  shall  show  the  name  and  address  of  the  contractor,  the  ar- 
ticles purchased,  quantity,  unit,  unit  price,  and  total  amount  as  shown 
by  the  public  voucher.    The  date,  voucher  number,  and  signature  of 
the  accountable  officer  shall  be  entered  thereon,  and  the  original  copy 
forwarded  promptly  to  the  Purveying  Depot,  attention  Property 
return  section.    The  duplicate  copy  shall  be  filed  with  the  retained 
Property  Vouchers  after  the  proper  debits  have  been  entered  on  the 
property  return.    This  invoice  shall  always  be  forwarded  under  sepa- 
rate cover  as  it  is  a  property  voucher  and  of  no  interest  to  the  section 
that  audits  the  public  voucher. 

EMERGENCY   PURCHASES. 

642.  When  the  necessity  to  purchase  supplies  or  equipment  or  make 
minor  repairs  at  the  station  is  urgent,  the  medical  officer  in  charge 
shall  advertise  by  poster  and  circular  letter  for  proposals  to  furnish 
the  supplies,  equipment,  or  repairs  needed,  and  forward  all  proposals 
received  to  the  Surgeon  General  by  letter  of  transmittal    (Form 
1907),  stating  his  recommendation  as  to  which  shall  be  approved  and 
the  reasons  therefor. 


101 

643.  For  such  absolutely  necessary  purchases  and  repairs  as  require 
immediate  attention  bills  involving  small  amounts  may  be  incurred 
without  special  authority;  but  it  must  be  clearly  shown  by  a  state- 
ment of  the  facts  in  the  case  that  the  expenditure  was  immediately 
necessary,  that  the  necessity  therefor  could  not  have  been  foreseen 
with  ordinary  care,  that  injury  to  the  public  interests  or  damage  to 
public  property  would  have  resulted  from  the  delay  necessary  to 
procure  authority  for  the  expenditure.    The  facts  must  be  stated  in 
full  on  the  face  of  the  voucher,  without  reference  to  any  statement 
that  may  be  made  in  the  letter  of  transmittal. 

644.  Three  methods  shall  be  used  in  purchasing  on  the  authority 
contained  in  the  preceding  paragraph. 

(a)  When  the  necessity  for  an  article  or  service  is  not  so  urgent  as  to 
prevent  the  purchase  thereof  on  competitive  proposal  received  by 
poster  and  circular-letter  advertisement,  this  course  should  be  fol- 
lowed and  the  lowest  and  most  advantageous  proposal  received  should 
be  accepted,  the  article  or  service  ordered  from  the  successful  bidder, 
and  all  proposals  received  forwarded  by  letter  (Form  1907)  to  the 
Surgeon  General,  together  with  the  voucher  for  said  expenditure. 
If  one  of  the  higher  proposals  received  is  accepted,  the  reasons  for 
such  action  shall  be  clearly  set  forth  on  the  face  of  the  voucher. 

(b)  When  the  necessity  for  an  article  or  service  is  so  urgent  as  to 
preclude  advertising  by  means  of  poster  and  circular  letter,  but  never- 
theless there  is  time  available  for  direct  personal  solicitation  of  com- 
petitive bids,  competition  shall  be  solicited  by  means  of  the  telephone, 
personal  visit,  or  otherwise.    In  such  case,  the  lowest  or  most  advan- 
tageous verbal  bid  should  be  accepted  and  the  order  placed.     The 
voucher  covering  said  expenditure  shall  show  the  manner  of  purchase 
and  the  fact  that  informal  bids  were  solicited,  after  the  letter  "  C," 
under  the  heading  "  Form  of  agreement,"  on  the  reverse  of  the  voucher 
blank  (Form  1949).    If  other  than  the  lowest  proposal  is  accepted, 
the  reasons  for  such  action  shall  be  clearly  set  forth  on  the  face  of  the 
voucher. 

'(<?)  When  the  necessity  for  an  article  or  service  is  so  urgent  that 
there  is  no  time  available  in  which  to  obtain  competitive  proposals  by 
either  of  the  methods  mentioned  in  the  two  preceding  paragraphs,  the 
article  or  service  required  may  be  procured  in  the  open  market  in  the 
manner  in  which  articles  are  usually  bought  and  sold  by  individuals. 
The  reason  why  it  was  not  practicable  to  obtain  competition  should  be 
stated  in  full  on  the  face  of  vouchers  for  expenditures  incurred  in  this 
manner. 

645.  Paragraph  643  should  be  cited  as  authority  on  all  vouchers  in- 
curred in  accordance  with  the  methods  described  in  paragraph  644, 
and  the  actual  circumstances  that  made  it  necessary  to  incur  the  ex- 


'  '?<,.;/'  102 

penditure  without  authority  should  be  stated  on  the  face  of  said 
vouchers. 

646.  It  is  not  possible  to  describe  definitely  an  exigency  expenditure 
such  as  is  contemplated  in  the  preceding  paragraphs,  but  in  general 
it  may  be  stated  that  it  covers  such  items  as  medicines  and  surgical 
supplies  (listed  on  the  supply  table),  which  are  immediately  needed 
and  not  in  stock,  the  repair  of  articles  in  daily  use  and  absolutely 
necessary  for  the  proper  administration  of  the  hospital^  such  as  surgi- 
cal instruments,  wagons,  harness,  ranges,  the  heating  plant,  and  im- 
portant utensils  used  in  the  hospital  kitchen,  which  must  be  replaced 
or  repaired  immediately.    These  may  be  considered  as  examples  of  an 
emergency  recognized  by  the  Surgeon  General  in  approving  bills  for- 
warded under  the  preceding  paragraphs. 

647.  The  items  enumerated  in  the  preceding  paragraph  are  given 
as  examples  of  a  public  exigency  that  may  justify  an  expenditure 
without  special  authority,  but  if  the  necessity  for  the  expenditure 
is  foreseen,  no  matter  what  the  object  of  it  may  be,  the  usual  pro- 
cedure should  be  followed. 

648.  In  the  event  that  competitiAre  proposals  to  furnish  certain 
articles  or  services  can  not  be  obtained,  a  letter  should  nevertheless 
be  addressed  to  the  Surgeon  General  asking  authority  to  incur  the 
expenditure. 

649.  In  the  absence  of  the  medical  officer  in  charge,  emergency 
purchases  may  be  ordered  by  the  officer  in  temporary  charge,  but 
should  be  reported  at  the  first  opportunity  to  the  medical  officer  in 
charge. 

650.  No  purchases  shall  be  made  by  junior  medical  officers  except 
when  unavoidable  and  in  the  absence  of  the  medical  officer  in  charge, 
or  unless  such  purchases  are  made  by  authority  of  the  medical  officer 
in  charge. 

651.  All  articles  purchased  (except  subsistence  supplies)  and  the 
contents  of  all  packages  and  boxes  received  by  freight  or  express, 
shall  be  held  for  the  inspection  of  the  medical  officer  in  charge,  or  the 
materiel  officer  before  being  issued. 

ARTICLE  XX. 
MEDICAL  AND  SURGICAL  SUPPLIES. 

652.  The  supply  table  issued  by  the  Surgeon  General  enumerates 
the  medical  supplies  issued  to  the  United  States  Public  Health  Serv- 
ice and  the  quantities  and  sizes  of  original  packages. 

653.  Medical  officers  shall  report  to  the  Surgeon  General  all  de- 
fects observed  in  the  quantity,  quality,  or  packing  of  medical  supplies. 
They  are  requested  to  freely  communicate  with  the  Surgeon  General 


103 

as  to  any  suggestions  tending  to  the  improvement  of  medical  sup- 
plies, appliances,  etc.,  and  to  make  reports  as  to  new  designs  of  ap- 
paratus, etc. 

654.  A  commissioned  officer  desirous  of  making  investigations  may 
apply  to  the  Surgeon  General  for  a  microscope  and  attachments, 
which,  when  furnished,  will  be  under  his  personal  charge,  and  he 
shall  be  responsible  for  its  care  and  preservation  and  shall  take  same 
with  him  when  changing  station  for  permanent  duty.    While  it  is  in 
his  charge  he  will  be  required  to  make  an  annual  property  return 
of  the  said  microscope  and  accessories. 

PROSTHETIC  AND  ORTHOPEDIC  APPARATUS. 

655.  District  supervisors  and  medical  officers  in  charge  of  first- 
class  stations  are  directed,  previous  to  June  30  and  December  31  of 
each  year,  to  obtain  proposals  by  advertisement  to  furnish  prosthetic 
appliances,  (except  artificial  limbs),  and  to  repair  prosthetic  appli- 
ances, including  artificial  limbs,  for  the  succeeding  six  months,  in 
order  that  beneficiaries   of  the  service  requiring   and    entitled   to 
same  by  existing  law  and  regulations  may  receive  suitable  appli- 
ances at  the  earliest  possible  date.     These  proposals  should  be  for- 
warded to  the  Purveying  Depot  with  definite  recommendations  as  to 
acceptance.    A  list  of  special  appliances  that  may  be  required,  with 
prices  considered  reasonable,  will  be  furnished  for  guidance  on  appli- 
cation to  the  bureau.    The  medical  officer  in  charge  will  be  "advised 
of  the  acceptance  of  proposals,  and  under  those  accepted  may  pur- 
chase such  articles  as  are  needed  by  the  beneficiaries  of  the  service 
without  special  authority  from  the  bureau. 

656.  When  it  is  necessary  to  furnish  an  appliance  which  is  not  cov- 
ered by  the  accepted  proposal,  separate  proposals  should  be  obtained 
by  poster  and  circular  letter  advertisement  for  the  article  desired,  for- 
warding all  proposals  received  in  duplicate  to  the  Surgeon  General, 
with  recommendations  as  to  acceptance. 

fc57.  Each  officer  purchasing  prosthetic  appliances  is  charged  to 
obtain  suitable  and  satisfactory  articles  at  the  most  reasonable  prices 
compatible  with  the  best  interests  of  the  patient  and  the  Govern- 
ment. On  delivery  of  any  piece  of  prosthetic  apparatus  a  receipt 
shall  be  obtained  from  the  patient  receiving  the.  same  and  placed  on 
file.  Each  voucher,  or  in  the  case  of  special  appliances,  each  proposal, 
shall  be  accompanied  by  a  detailed  report  stating  the  name  of  the 
patient,  diagnosis,  present  physical  condition,  indications  for  treat- 
ment, and  description  of  the  article,  together  with  a  statement  that 
the  article  is  required,  and  that  the  proposal  recommended  for  ac- 
ceptance is  considered  reasonable  and  just,  which  report  and  state- 
ment will  be  signed  by  the  attending  specialist  who  is  treating  the 


104 

patient.    In  every  case  a  duplicate  of  this  statement  should  be  for- 
warded to  the  supervisor  of  the  district  for  his  information  and  file. 

ARTICLE  XXI. 

SUBSISTENCE,  PBOPOSALS,  AND  CONTRACTS. 

658.  Articles  of  subsistence,  fuel,  ice,  janitor's  and  laundry  sup- 
plies, oils,  and  forage,  not  furnished  from  the  bureau  or  purveying 
depot,  shall  be  bought  for  service  stations,  whenever  practicable, 
on  approved  proposals  taken  by  advertisement,  covering  a  period 
of  three  months,  or  on  contract  covering  a  longer  period,  secured  by  a 
bond. 

659.  On  the  1st  day  of  April  of  each  year,  the  medical  officer  in 
charge  of  each  service  "station  requiring  subsistence  supplies  shall 
forward  to  the  Surgeon  General  an  estimate  in  duplicate  of  the 
quantities  of  subsistence  and  other  supplies  required  for  consump- 
tion during  the  coming  fiscal  year  (Form  1910). 

660.  The  ordinary  articles  and  quantities  of  subsistence  supplies 
for  10,000  full  rations  shall  not  exceed  the  contract  value  of  8,000 
pounds  of  meat,  fresh  and  salt ;  2,000  pounds  of  fish,  fresh  and  salt ; 
10,000  pounds  of  vegetables;  10,000  pounds  of  breadstuffs  and  other 
prepared  farinaceous  food ;  100  pounds  of  tea ;  300  pounds  of  coffee ; 
1,500  pounds  of  sugar;  25  gallons  of  molasses  or  sirup;  800  gallons 
of  milk^  1,000  pounds  of  butter  or  cheese;  300  dozen  of  eggs;  300 
pounds  of  lard;  1,500  pounds  of  fresh  and  dry  fruit;  500  pounds 
of  salt;  25  pounds  of  pepper;  25  gallons  of  vinegar;  25  gallons  of 
pickles. 

661.  Upon  receipt  of  the  approval  of  the  annual  estimate  of  sup- 
plies needed,  schedules  of  articles  on  which  proposals  are  to  be 
solicited  shall  be  prepared.     The  articles  listed  thereon  shall   be 
specified  as  to  kind  and  quality,  and  the  estimate  of  quantities  to  be 
bought  during  the  period  of  time  covered  by  the  proposal  shall  be 
shown  in  the  proper  column  on  the  proposal  blank   (Form  1911). 
When  considered  advisable,  several  grades  of  an  article  may  be  speci- 
fied ;  for  instance,  eggs,  strictly  fresh,  and  eggs,  storage.    The  weight, 

.  size,  or  volume  of  the  unit  shall  be  given  in  order  that  bidders  may 
have  no  doubt  as  to  the  articles  or  supplies  required. 

662.  Separate  schedules  shall  be  prepared  for  each  class  of  articles 
listed  on  the  estimate  sheet,  namely,  for  meats  and  poultry,  fish  and 
oysters,  fruits  and  vegetables,  janitor's  and  laundry  supplies,  milk, 
butter  and  eggs,  groceries,  breadstuffs,  forage,  ice,  fuel,  and  oils. 
These  schedules  shall  be  furnished  in  duplicate  to  all  responsible 
persons  who  may  call  for  them  with  the  purpose  of  submitting 
bids ;  but  bidders  must  be  actual  dealers  in  the  articles  they  propose 


105 

to  furnish,  and  the  medical  officer  in  charge  may  refuse  to  furnish 
schedules  to  defaulting  contractors. 

663.  If  more  advantageous  to  the  service  at  particular  stations  to 
separate  certain  articles  from  any  of  the  groups  referred  to,  in  order 
to  obtain  separate  proposals  from  dealers  therein,  the  schedules  may 
be  made  out  accordingly,  or  they  may  be  grouped  together  to  secure 
combined  proposals,  in  the  discretion  of  the  medical  officer  in  charge. 

684.  When  the  interests  of  the  Government  seem  to  require  it,  arti- 
cles may  be  described  by  trade  names,  provided  the  words  "  or  equal " 
are  written  after  the  description.  In  such  case  dealers  should  be 
made  to  understand  that  articles  offered  at  the  lowest  prices  will  be 
purchased,  if  they  are  satisfactory,  even  though  they  are  not  of  the 
make  or  brand  specified.  If  articles  offered  on  such  specifications  are 
not  satisfactory,  an  explanatory  statement  showing  that  they  are  not 
suited  to  the  needs  of  the  station  must  be  made  in  the. letter  of  trans- 
inittal. 

665.  The  medical  officer  in  charge  may  require  bidders  to  submit 
yamples  of  the  supplies  they  propose  to  furnish,  and  the  quality  of 
the  samples  submitted  as  well  as  the  prices  will  govern  the  recom- 
mendations of  the  medical  officer  in  charge  as  to  the  acceptance  of  any 
bid. 

666.  The  proposals  received  shall  be  opened  at  the  time  specified  in 
the  advertisement  by  the  medical  officer  in  charge  of  a  service  sta- 
tion, in  the  presence  of  such  bidders  as  may  present  themselves. 

667.  The  items  on  all  proposals  should  be  extended  at  the  hospital, 
the  total  cost  of  them  added,  and  the  letter  of  transmittal  should  list 
the  amount  of  each  proposal  opposite  the  name  of  the  bidder,  so  that 
a  comparison  may  be  made  of  the  totals  of  all  bids  on  one  schedule. 
Said  letter  should  state  the  number  of  schedules  distributed. 

668.  Should  there  be  reason  to  suspect  collusion  among  dealers  to 
obtain  more  than  a  fair  market  price  for  articles  required  to  be  pur- 
chased, or  should  the  prices  proposed  be  exorbitant,  the  proposals 
should  be  rejected,  and  other  dealers  should  be  invited  by  poster  and 
circular  letter   advertisement   to   submit   proposals.     If  necessary, 
authority  "will  be  given  to  purchase  in  the  open  market  at  the  lowest 
prices  obtainable  for  satisfactory  supplies. 

669.  Upon  receipt  of  notification  from  the  Surgeon  General  as  to 
the  acceptance  of  proposals,  covering  a  longer  period  than  three 
months,  the  medical  officer  in  charge  of  a  service  station  will  enter 
into  formal  contract  with  the  bidders  whose  proposals  have  been 
accepted;  the  contract  shall  be  made  out  in  quadruplicate  upon  the 
blank  form  furnished  by  the  department  for  that  purpose,  and  when 
completed,  the  original  and  one  copy  of  each  contract  shall  be  trans- 
mitted to  the  Surgeon  General  for  approval  by  the  Secretary  of  the 
Treasury. 


106 

670.  The  Surgeon  General  is  authorized  to  approve  all  quarterly 
proposals  received  after  poster  and  circular  letter  advertisement  to 
furnish  subsistence  and  other  supplies  without  regard  to  the  cost  of 
such  supplies.    When  there  is  delay  in  receipt  of  the  notification  as 
to  the  action  of  the  Surgeon  General  on  subsistence  proposals  recom- 
mended for  acceptance,,  and  the  period  of  time  covered  by  these  pro  - 
posals  has  begun,,  supplies  should  be  bought  in  accordance  with  the 
officer's  recommendation  until  the  receipt  of  definite  information 
from  the  Surgeon  General. 

671.  When  quarterly  proposals  to  furnish  subsistence  and  other 
supplies  can  not  be  obtained  after  advertising,  or  when  those  received 
show  prices  too  high  for  acceptance,  the  Surgeon  General  is  author- 
ized to  approve  the  purchase  of  said  supplies  in  the  open  market  dur- 
ing the  three  months  specified  in  the  proposals. 

672.  Newspaper  advertisements,  when  considered  necessary  by  the 
Surgeon  General  shall  be  inserted  in  such  newspapers  as  the  Secre- 
tary of  the  Treasury  (through  the  Division  of  Printing  and  Station- 
ery) may  direct,  and  no  bill  for  advertising  will  be  paid  unless  there 
be  presented  with  the  bill  the  original  or  a  copy  of  the  written 
authority   from  the  Division  of  Printing  and   Stationery  to   ad- 
vertise. 

673.  To  meet  the  requirements  of  section  3709,  Revised  Statutes, 
an  advertisement  need  not  necessarily  be  by  publication  in  the  news- 
papers but  by  displaying  a  poster  in  a  public  place  and  sending  circu- 
lars to  persons  furnishing  the  supplies  desired.    The  lobby  of  the  post 
office  is  regarded 'as  a  suitable  place  for  the  display  of  posters. 

674.  The  circular  letters  and  posters  should  be  drawn  in  similar 
language  and  copies  of  both  should  be  forwarded  to  the  Surgeon 
General  with  the  proposals.    When  quarterly  proposals  are  solicited, 
the  poster  and  circular  letter  should  state  that  bond  will  not  be  re- 
quired. 

675.  Advertisements  must  be  made  early  enough  to  allow  dealers 
and  others  sufficient  time  in  which  to  make  inquiries  and  to  prepare 
and  deliver  their  proposals.     The  length  of  time  required  willr  of 
course,  vary  with  circumstances.    There  may  be  occasions  when  one 
day  will  be  sufficient;  but  in  general,  not  less  than  a  week  should 
be  allowed,  and  when  the  specifications  are  such  as  to  make  necessary 
numerous  inquiries  and  calculations,  a  longer  time  should  be  given. 

676.  Dealers  should  be  instructed  that  the  proposals  must  be  signed 
in  duplicate  with  the  firm  signature  and  be  delivered  in  triplicate  in 
a  sealed  envelope  addressed  to  the  medical  officer  in  charge  of  the 
station  and  marked  "  Proposals  for  hospital  supplies." 

677.  Proposals  from  at  least  three  dealers  in  each  class  of  supplies 
should  be  solicited  if  possible. 


107 

678.  Medical  officers  in  charge  of  service  stations  shall  make  rea- 
sonable effort  to  induce  the  largest  and  most  responsible  dealers  at  the 
station  to  submit  proposals  to  furnish  subsistence  and  other  supplies. 

679.  Contracts  for  subsistence  and  other  supplies  shall  be  made 
for  a  fiscal  year  or  some  part  thereof. 

680.  The  contract  shall  be  signed  in  the  firm  name,  without  seals, 
but  the  bond  accompanying  the  contract  must  be  signed  by  the  indi- 
vidual members  of  the  firm  and  their  sureties,  and  each  signature  to 
the  bond  must  have  a  seal  attached.    When  a  person  signs  a  contract 
for  a  company,  a  power  of  attorney  or  other  satisfactory  written  evi- 
dence that  he  is  authorized  to  act  for  the  company  by  entering  into 
contract  and  executing  bond  in  its  behalf  must  be  attached  to  the 
contract. 

681    Formal  contracts  with  bonds  and  sureties  shall  be  prepared 
on  the  blank  form  furnished  for  that  purpose  (Form  1913). 

682.  Officers  on  duty  at  service  stations  shall  have  the  privilege  of 
purchasing  ordinary  subsistence  supplies  at  the  contract  rates  from 
contractors  furnishing  said  stations,  and  a  clause  to  that  effect  may 
be  included  in  quarterly  proposals  or  formal  contracts. 

683.  Authority  to  incur  expenditures  of  $100  or  over  for  labor,  ma- 
terial, equipment,  or  supplies,  other  than  subsistence  and  the  other 
supplies  bought  on  quarterly  proposals,  must  be  secured  from  the 
Secretary  of  the  Treasury,  through  the  Surgeon  General.     The  Sur- 
geon General  may  authorize  expenditures  of  less  than  $100  each. 

684.  Articles  and  supplies  purchased  for  the  service  before  being 
accepted  by  the  person  authorized  to  receive  them  must  be  carefully 
inspected,  and  shall  be  rejected  unless  of  good  quality,  corresponding 
to  the  specifications  in  the  bid,  and  in  every  respect  satisfactory. 

685.  Medical  officers  in  charge  of  service  stations  shall  from  time 
to  time  inspect  the  supplies  furnished  under  contract,  and  shall  reject 
such  as  are  of  inferior  quality. 


686.  When  it  becomes  necessary  to  prepare  formal  leases  covering 
office  and  other  quarters  rented  to  the  Public  Health  Service,  the 
lease  in  general  use  by  the  person  or  company  renting  the  property 
may  be  used,  provided  its  terms  are  modified  to  meet  the  require- 
ments of  the  Government.  The  Revised  Statutes  of  the  United 
States  (Sec.  3648)  prohibit  the  advance  payment  of  public  moneys 
and  rent  can  only  be  paid  at  the  end  of  specified  periods — monthly, 
quarterly,  or  annually.  Unless  paid  from  a  specific  and  continuing 
appropriation  no  lease  can  be  drawn  extending  beyond  a  fiscal  year. 


108 

It  is  possible,  however,  to  provide  that  the  period  of  occupancy  shall 
extend  over  a  term  of  years,  contingent  upon  the  making  available 
by  Congress  of  appropriations  out  of  which  the  rent  may  be  paid 
for  periods  beyond  the  fiscal  year  in  which  the  agreement  is  made. 

687.  The  Government  can  make  repairs  or  alterations  to  rented 
property  only  when  such  work  is  included  in  the  agreement  as  u 
part  of  the  rent.     Such  an  arrangement  is  to  be  avoided,  if  possible, 
but,  when  the  needs  of  the  service  require  it,  proposals  for  lease  of 
property  upon  such  terms  should  be  forwarded  for  the  required  de- 
partmental action.    It  has  been  ruled  that  call  bells  or  buzzers,  and 
intercummunicating  telephones  are  office  equipment,  and  can  be  in- 
stalled in  leased  buildings. 

ARTICLE  XXII. 
VOUCHERS. 

688.  All  formal  contracts  shall  receive  the  approval  of  the  depart- 
ment before  they  are  effective.     Proposals  received  under  poster  and 
circular  letter  or  other  advertisement  shall  be  approved  by  the  Sur- 
geon General  or  the  Secretary  of  the  Treasury.     Vouchers  for  ex- 
penditures so  authorized  should  cite  the  bureau  or  department  ap- 
proval on  which  the  expenditure  was  incurred  as  authority  therefor. 

689.  All  vouchers  on  account  of  the  service  must  be  rendered  on' 
the  proper  blanks.    They  must  be  itemized  and  in  cases  where  serv- 
ices or  articles  are  furnished  patients  the  names  and  class  of  the 
patients  must  be  given  and  the  items  specified. 

690.  As  far  as  practicable  every  bill  incurred  on  account  of  the 
service  will  be  obtained  and  promptly  forwarded  at  the  close  of  each 
month  to  the  Surgeon  General.     All  supplies  or  services  of  one 
character  furnished  by  one  payee  during  a  calendar  month  should 
be  embodied  in  one  voucher,  unless  an  expenditure  in  definite  amount 
is  authorized,  in  which  case  one  voucher  should  be  submitted  for  the 
amount  of  said  expenditure.     Expenditures  incurred  on  approved 
proposal  should  be  vouchered  in  the  terms  of  the  proposal. 

691  Vouchers  presented  for  payment  must  be  prepared  in  accord- 
ance with  instructions  appearing  thereon. 

692.  Vouchers  will  be  forwarded  with  letters  of  transmittal  only 
when  it  is  necessary  to  make  some  explanation  concerning  the  same 
for  the  information  of  the  bureau.  A  memorandum  list  should, 
however,  accompany  vouchers  forwarded  in  one  day.  Said  list 
should  show  the  name  of  the  station,  date  of  forwarding,  the  names 
of  the  payees,  the  character  of  service  or  supplies  rendered,  and 
the  amount  of  each  voucher. 


109 

693.  Vouchers  for  articles  embraced  in  an  approved  proposal  must 
contain  no  other  items. 

694.  By  virtue  of  contract,  the  records  of  hospitals  in  which  bene- 
ficiaries of  the  service  are  treated  are  official  records  in  so  far  as  re- 
lated to  information  concerning  such  beneficiaries  and  the  monthly 
vouchers  shall  be  a  transcript  of  these  records.    Officers  verifying  or 
certifying  to  monthly  vouchers  for  the  care  of  patients  in  contract 
hospitals  will  satisfy  themselves  that  the  services  certified  have  been 
rendered  as  stated  and  in  no  case  shall  vouchers  be  certified  unless 
satisfactory  evidence  on  which  certification  is  based  has  been  fur- 
nished the  officer  making  the  certificate. 

695.  The  necessary  medicines  furnished  patients  of  the  service  by 
apothecaries  upon  the  prescriptions  of  physicians  authorized  to  pre- 
scribe for  such '  patients  will  be  paid  for  at  the  lowest  current  and 
just  prices  charged  the  public  at  the  time  and  place,  bills  to  be 
rendered  in  due  form  by  the  apothecary  and  certified  by  the  officer 
authorizing  the  expenditure. 

696.  Bills  for  medicines  dispensed  to  sick  and  disabled  patients 
upon  the  prescriptions  of  medical  officers  or  attending  physicians 
should  state  the  names  and  class  of  the  patients  prescribed  for,  and 
should  be  accompanied  with  copies  of  prescriptions,  with  the  num- 
ber and  price  of  each  shown  thereon. 

697.  All  official  telegrams  should  be  sent  at  Government  rates  and 
those  to  the  bureau  sent  Government  rates  "  collect."    All  cable  mes- 
sages must  be  prepaid  by  the  sender.     Existing  arrangements  with 
the  telegraph  companies  provide  that  tolls  may  be  paid  in  one  of 
three  ways,  as  follows : 

(a)  The  tolls  may  be  paid  in  cash  at  the  time  of  filing  or  upon  the 
delivery  of  a  collect  message. 

(5)  A  local  monthly  charge  account  may  be  opened  to  which  the 
tolls  may  be  charged,  to  be  settled  in  cash  promptly  at  the  close 
of  the  month  at  the  local  office. 

(c)  Settlement  of  telegraph  accounts  may  be  made  between  the 
bureau  and  the  telegraph  companies.  In  this  case  copies  of  the  mes- 
sages are  forwarded  by  the  companies  to  Washington  for  collection. 

If  the  company  insists  on  payment  according  to  terms  of  either  of 
the  first  two  ways  above  mentioned,  the  officer  will  pay  the  charges 
and  submit  voucher  for  reimbursement  with  the  facts  noted.  The 
third  method  mentioned  above  is  preferred,  since  the  settlement  of 
telegraph  accounts  will  then  rest  on  the  bureau  alone.  This  method 
should  be  observed  whenever  possible. 

Whenever  it  shall  be  necessary  for  officers  to  make  use  of  the  tele- 
graph on  official  business,  due  care  will  be  taken  to  make  the  same 
as  brief  as  is  consistent  with  clearness.  Initials  of  names  will  be 


110 

omitted  in  the  address  and  signature.  Same  shall  be  endorsed  "  Offi- 
cial business  "  by  the  sender  with  his  name  and  title  and  telegraph 
identification  card  number. 

Telegrams  making  application  for  leave  of  absence  or  extension  of 
leave  or  of  inquiry  whether  leave  has  been  granted,  and  the  replies 
made  thereto  by  telegraph,  are  not  official  business  and  will  not  be 
sent  or  paid  for  at  the  expense  of  the  service.  Answers  to  cable  mes- 
sages must  be  prepaid  by  sender. 

698.  Vouchers  for  telephone  toll  service  not  covered  by  existing 
contracts  should  be  itemized  to  show  the  number  of  messages  to  one 
place  at  the  same  rate.     If  a  greater  rate  than  the  minimum  is 
charged,  the  number  of  minutes  charged  should  be  shown.    Copies 
of  telephone  messages  need  not  accompany  vouchers  for  toll  service, 
but  such  vouchers  should  bear  a  statement  showing  that  the  message 
was  on  official  business  at  the  rate  charged  the  public.    Reimburse- 
ment vouchers,  should  be   accompanied"  with   subvouchers   for   all 
amounts  over  $1. 

699.  Vouchers  for  telephone  service  on  contract  should  bear  a 
statement  showing  that  no  expenditure  thereon  was  incurred  for 
private  business. 

700.  When  an  amount  approved  for  any  specific  purpose  or  pur- 
chase proves  insufficient,  authority  must  be  obtained  for  any  addi- 
tional expenditure  before  submitting  vouchers  for  payment. 

701.  Subvouchers  should  accompany  vouchers  to  which  they  per- 
tain, but  should  not  be  fastened  thereto  with  mucilage  or  staples. 

ARTICLE  XXIII. 

CUSTODIANS. 

702.  At  all  stations  the  medical  officer  in  charge  will  be  appointed 
custodian,  ex  officio,  by  the  Secretary  of  the  Treasury,  of  the  buildings 
and  property  constituting  the  station,  and  he  will  have  responsible 
custody  and  supervision  of  the  buildings  and  grounds  and  of  the 
necessary  repairs  thereto. 

703.  The  specific  duties  of  officers  who  are  appointed  as  custodians 
are  detailed  in  an  official  publication  of  the  Treasury  Department 
entitled  "  Instructions  to  Custodians  of  Public  Buildings,"  and  the 
rules  and  regulations  therein  set  forth,  in  so  far  as  applicable,  shall 
be  complied  with  by  officers  and  others. 

704.  Custodians  may,  when  necessary,  submit  to  the  department 
for  approval  the  nomination  of  a  suitable  official  for  appointment  as 
acting  custodian,  to  serve  during  the  absence  of  the  custodian  by 
reason  of  sickness  or  any  other  cause;  but  such  person  shall  not  act 
until  his  nomination  is  approved  by  the  department. 


Ill 

705.  Custodians  shall  forward  to  the  bureau  annually,  on  the  30th 
of  June,  diagrams  of  the  different  floors  of  the  buildings  under  their 
charge,  showing  the  assignment  and  occupation  of  all  rooms  therein. 

706.  Custodians  shall  take  suitable  measures  to  preserve  order 
about  the  buildings  and  grounds  and  to  prevent  trespass,  destruction 
of  trees,  fences,  or  walls  inclosing  the  hospital  and  quarantine  reser- 
vations.    They  shall  report  to  the  United  States  attorney  of  the 
judicial  district  in  which  the  reservation  is  situated  any  serious  in- 
fractions of  this  provision. 

707.  Custodians  will  not  allow  any  of  the  rooms  in  the  building  to 
be  used  for  other  than  official  purposes  except  those  assigned  as 
quarters. 

708.  Custodians  will  forward  to  the  bureau  annually,  on  the  31st 
of  December,  a  list  of  the  furniture  in  the  quarters  of  officers,  show- 
ing the  number  of  articles  of  furniture  in  each  room  and  the  condi- 
tion of  each  article. 

709.  Any  necessity  for  repairs  or  alterations  of  the  buildings,  of 
the   approaches  to  the  buildings,  or  of  the   fences  inclosing  the 
grounds,  will  be  promptly  reported  by  the  custodian  to  the  Surgeon 
General,  together  with  an  estimate  of  the  cost  of  making  the  same 
and  his  recommendation  in  regard  thereto.     If  the  necessary  repairs 
or  alterations  are  extensive  or  of  a  character  requiring  special  tech- 
nical attention,  a  superintendent  of  construction  or  other  qualified 
representative  of  the  department  will  be  ordered  to  make  an  in- 
spection and  report  and  to  prepare  the  necessary  data  upon  which 
proposals  for  the  work  approved  may  be  secured. 

710.  Custodians  shall  not  remove  trees  or  shrubbery  from  the  res- 
ervation nor  change  existing  fences  without  written  authority  from 
the  Surgeon  General. 

711.  Custodians  in  charge  of  leased  buildings  will  make  application 
to  renew  leases  at  least  60  days  before  the  notice  of  renewal  or  relin- 
quishment  is  required  by  the  terms  of  the  lease,  giving  a  list  of  all 
buildings  and  rooms  rented  at  their  station,  the  purposes  and  periods 
for  which  they  are  leased,  the  annual  rent  paid,  stating  that  the 
premises  are  suitable  for  the  purposes  designed,  that  the  rent  charged 
is  the  lowest  for  which  suitable  premises  can  be  obtained,  and  that 
the  lessor  can  give  a  valid  lease. 

712.  Special  attention  to  economy  in  the  use  of  gas,  electric  lights, 
and  water  is  enjoined  upon  custodians,  who  will  cause  employees  and 
others  concerned  in  their  control  to  promptly  extinguish  all  lights 
not  absolutely  required  for  the  proper  transaction  of  official  business 
in  the  executive  portions  of  the  buildings  under  their  charge.    Water 
must  be  economically  used. 


112 

713.  Each  voucher  for  fuel  must  be  accompanied  by  a  certificate  of 
inspection  signed  by  an  employee  of  the  service  who  shall  have  been 
designated  by  the  custodian  to  inspect,  weigh,  and  measure  all  sup- 
plies of  fuel.    Blank  forms  for  such  certification  will  be  furnished  by 
the  department. 

714.  Persons  or  corporations  demanding  payments  in  advance  for 
gas,  water,  or  other  service,  or  supplies  for  public  use,  will  be  notified 
that,  under  the  restrictive  provisions  of  the  statutes,  no  account  can 
be  paid  except  for  service,  etc.,  rendered  at  the  date  of  presentation 
of  such  account. 

715.  The  custodian  will  be  in  immediate  charge  of  organizing  effi- 
cient measures  for  the  prevention  and  control  of  fire  at  the  station . 
to  which  he  is  assigned.  He  shall  make  recommendations  for  the  sup- 
ply of  all  necessary  equipment  for  the  purpose  and  shall  give  direct 
attention  to  its  proper  installation  and  maintenance.    No  axe,  crow- 
bar, or  other  fire-fighting  apparatus  which  might  be  used  as  a  weapon 
shall  be  kept  in  any  ward  or  patient's  room. 

716.  The  cilstodian  shall  prepare  and  publish  suitable  regulations 
governing  the  officers  and  employees  of  the  station,  both  as  to  the 
prevention  and  control  of  fires. 

717.  At  stations  where  a  permanent  crew  of  fire  fighters  is  main- 
tained these  regulations  shall  provide  for  such  auxiliary  organiza- 
tion composed  of  employees  as  may  be  necessary  for  protecting  the 
lives  of  patients  and  safeguarding  the  station.  \. 

718.  At  stations  where  no  permanent  crew  of  fire  fighters  is  main- 
tained the  regulations  shall  show  in  detail  the  organization  of  the 
personnel  assigned  to  the  station. 

719.  These  regulations  shall  assign  specific  duties  to  each  member 
of   the   fire-fighting   organization,  and  they   shall  be   periodically 
drilled  in  those  duties  in  such  manner  as  will  best  prepare  them  for 
meeting  all  possible  emergencies. 

720.  Copies  of  the  fire  regulations  shall  be  framed  and  posted  in 
the  executive  building  and  other  conspicuous  places  about  the  sta- 
tion and  each  member  of  the  fire-fighting  organization  shall  be 
furnished  with  excerpts  defining  his  duties,  which  he  shall  be  re- 
quired to  keep  posted  in  his  quarters. 


APPENDIX. 


REGISTER  OF  PATIENTS. 

StJPPIfEMENTAL  INSTRUCTIONS  FOR  THE  PREPARATION  OF  FORMS  1971-E 
AND  1971-F. 

Serial  number. — The  serial  number  is  to  be  filled  in  at  offices 
of  district  supervisors  only,  and  bears  no  relation  to  the  register 
number  given  to  the  patient  by  an  examiner,  out-patient  office  or 
hospital. 

District. — The  number  of  the  district  from  which  the  patient  was 
received  will  be  recorded  in  upper  right  corner  of  the  card. 

Place  of  examination  (Form  1971-E). — Indicate  the  city  and 
State,  if  the  examination  is  conducted  by  an  examiner  not  attached 
to  a  hospital. 

Name  and  address  of  hospital  (Form  1971-F) . — If  a  civil  hospital, 
indicate  correct  name,  city,  and  State  in  which  located ;  if  a  service 
hospital,  "  U.  S.  P.  H.  S."  or  "  U.  S.  Marine  "  Hospital  No.  — ,  as  the 
case  may  be,  together  with  the  city  and  State  in  which  the  hospital 
is  located. 

Register  number. — Register  numbers  will  be  consecutive  and  con- 
tinuous. 

Name. — The  surname  is  to  be  written  first  in  all  instances.  Initial 
letters  or  abbreviations  may  be  used  for  middle  names  only.  All 
names  must  be  correctly  and  legibly  written. 

Permanent  address. — The  permanent  address  of  the  patient  must 
be  given  in  all  cases.  If  a  recent  change  in  permanent  address  has 
been  made,  this  fact  should  be  noted  by  the  words  "  Recent  change." 

Name  and  address  of  nearest  relative. — Name  and  address  of 
nearest  relative,  on  Form  1971-F,  should  be  written  in  full,  great 
care  being  taken  in  order  that  the  spelling  may  be  correct  in  every 
detail. 

Class  of  beneficiary. — The  following  abbreviations  descriptive  of 
"class"  are  approved: 

Merchant  seaman=M.  S. 
Foreign  seaman=F.  S. 
War-risk  insurance =W.  R.  I. 
Army=A. 
Navy=N. 

Coast  Guard =C.  G. 
185279°— 20 8  113 


114 

Public  Health  Service=P.  H.  S. 
Lighthouse  Service=L.  H.  S.  . 
Bureau  of  Fisheries=B.  F. 
Engineer  Corps,  Army=E.  C.  U.  S.  A. 
Coast  and  Geodetic  Survey  =C.  &  G.  S. 
Bureau  of  Fisheriesr=B.  F. 

Employees'  Compensation  Commission=E.  C.  C. 
Federal  Board  for  Vocational  Education=F.  B.  V.  E. 
Discharged  Canadian  soldier=D.  C.  S. 
Discharged  allied  soldierr=D.  A.  S. 

Compensation  wumber. — Also  known  as  claim  number,  is  the  num- 
ber shown  on  the  papers  of  a  patient  of  the  Bureau  of  War  Risk 
Insurance,  as  "  C-(No.) ."  It  is  assigned  by  the  Bureau  of  War  Risk 
Insurance.  If  a  patient  has  no  claim  number,  record  as  "  C — pend- 
ing," 

Rank  and  organization. — The  former  rank  of  beneficiaries  of  the 

Bureau  of  War  Risk  Insurance  and  Federal  Board  for  Vocational 

Education.;  the  present  rank  <of  enlisted  men  of  the  Army  and  Navy. 

Age. — The  age  at  birthday  nearest  to  date  of  examination  should 

be  given. 

Race. — Refers  to  "white,"  "colored,"  "Filipino,"  "Porto  Rican," 
"Hawaiian,"  or  "Indian." 

Marital  condition. — Indicate  by  check  after  the  word  applying. 
Religion. — Should  not  be  abbreviated. 

Nativity. — Place  of  birth.  Give  State,  if  a  native;  country,  if 
foreign. 

Occupation. — Refers  to  civil  occupation. 

Source. — The  name  of  the  examiner,  officer  of  the  Public  Health 
Service,  service  hospital,  contract  hospital,  or  ship  from  which  the 
patient  is  received.  State  whether  application  is  "  voluntary "  or 
"  authorized." 

Date  of  last  service. — If  a  seaman,  the  date  of  last  service  on 
ship;  if  a  patient  who  has  been  discharged  from  militarj^  or  naval 
forces,  date  of  discharge. 

Authority. — The  circular  letter,  paragraph  of  the  Service  Regu- 
lations, or  other  authorization  should  be  given,  as  "Departmental 
Circular  No.  —  ";  "  Paragraph  — ,  P.  H.  S.  R." 

Date  of  original  examination  (Form  197 1-E}. — Indicate  date  of 
examination  for  which  Form  1971-E  is  being  prepared — not  the 
date  of  any  previous  examination.  This  date  will  be  the  same  as 
the  date  of  disposition  only  in  those  cases  in  which  the  patient  is 
given  examination  alone,  or  is  otherwise  disposed  of  the  same  day. 
Date  of  admission  (Form  1971-F). — Care  should  be  taken -to  indi- 
cate the  exact  date  on  which  the  patient  enters  the  hospital.  On 
this  depends  the  prompt  payment  of  bills  due  the  civil  hospitals. 


115 

Diagnosis — Name. — Must  be  in  accordance  with  official  "  Nomen- 
clature," P.  H.  S.  If  disease  is  localized  or  if  an  injury,  its 
location  should  be  definitely  stated,  i.  e.,  "  wound  of  arm,  gunshot 
(primary)  2040  S";  "  ankylosis  of  elbow  (secondary)  108."  When 
a  patient  has  two  or  more  diseases  or  injuries  at  the  time  of  admis- 
sion, each  of  them  will  be  recorded  under  this  heading.  If  the 
patient  is  received  by  transfer  and  the  diagnosis  made  after  admis- 
sion differs  from  that  on  the  transfer  card,  the  additional  entry  will 
be  made  "  Diagnosis  on  transfer  card  not  concurred  in."  If  a  case 
admitted  for  operation,  the  words  "  For  operation  "  should  be  in- 
serted in  parenthesis  after  the  name  of  the  disease. 

Diagnosis — Number. — The  number  relates  to  the  number  of  the 
disease  or  complication  as  given  in  the  "  Nomenclature  of  Diseases," 
U.  S.  P.  H.  S. 

Basis  for  diagnosis  (Form  197 1-E). — Record  under  this  head  the 
manner  in  which  diagnosis  was  determined — by  the  clinical  history, 
physical  examination,  laboratory  findings,  or  otherwise. 

Complication,  sequelae,  etc. — Record  complications,  intercurrent 
diseases,  and  changes  of  diagnosis  appearing  subsequent  to  the  di- 
agnosis made  at  the  time  of  examination,  giving  the  date  in  each 
instance.  Changes  of  diagnosis  should  be  recorded  in  red  ink.  No 
condition  should  be  stated  as  an  "intercurrent  disease"  which  is 
in  any  way  dependent  upon  the  primary  affection.  Should  the 
intercurrent  disability  be  cured  before  final  disposition  of  the  pa- 
tient, the  fact  and  date  of  cure  will  also  be  recorded  in  this  space. 

W here  was  sickness  or  disability  incurred. — Indicate  as,  "  In  the 
military  service  at "  or  "  On  board  (name  of  ship)." 

How  incurred. — Task  being  performed,  as  "  in  action,"  "  driving 
an  automobile,"  "adjusting  rigging,"  etc.  "Line  of  duty"  should 
be  given  only  when  a  more  definite  term  can  not  be  used. 

Operation  (Form  1971-F). — The  character  of  a  surgical  operation 
will  be  briefly  described  by  the  commonly  accepted  name.  Kind  of 
anaesthetic  will  be  stated. 

Disposition  (Form  197 1-E). — The  completion  of  a  case  will  be 
stated  by  entry  specifying  the  method  of  completion,  as  follows: 
"  Examined  " ;  "  Examined  and  furnished  office  treatment " ;  "  Trans- 
ferred to  for  examination " ;  "  Transferred  to  for 

examination  and  treatment." 

Disposition  (Form  1971-F). — The  completion  of  a  case  will  be 
indicated  as  follows:  "Discharged";  "Deserted";  "Recovered"; 
"  Died."  The  result  of  the  autopsy,  if  one  was  held,  will  be  stated. 
When  disease  or  injury  has  been  aggravated  by  the  willful  and  per- 
sistent refusal  of  the  patient  to  submit  to  such  reasonable  restrictions, 
methods  of  treatment,  or  operative  procedures  as  would  in  the  opinion 


116 

of  the  medical  officer  have  conduced  to  the  cure  or  to  the  lessening 
of  the  disability,  the  fact  should  be  noted  in  this  space. 

In  all  cases  of  transfer,  the  specific  destination  of  the  patient 
should  be  stated,  including  the  correct  name  of  the  office  or  hospital, 
and  the  name  of  the  city. 

Date  of  disposition. — This  date  bears  the  same  relation  to  the 
checking  of  bills,  etc.,  as  the  date  of  admission  to  hospital,  or  date 
of  original  examination  of  an  out-patient.  It  is,  therefore,  exceed- 
ingly important  that  this  date  be  supplied  and  that  it  be  accurate. 
In  recording  dates,  figures  should  not  be  used  to  designate  the  month. 

Cards  will  be  legibly  written,  using  the  typewriter  when  practi- 
cable ;  otherwise  ink  must  be  used  in  all  cases.  Entries  must  not  be 
crowded,  and  when  the  space  provided  under  any  heading  is  not 
sufficient  to  complete  an  entry  thereunder,  an  extension  slip  may  be 
used,  which  must  be  of  the  same  size  as  the  card.  It  must  be  pasted 
to  the  lower  margin  of  the  back  of  the  card,  using  about  half  an 
inch  for  the  seam.  When  an  entry  is  continued  on  an  extension 
slip,  the  two  parts  should  be  connected  by  cross  references,  using  a 
small  letter  in  parenthesis,  so  that  the  record  can  be  readily  followed. 
In  preparing  Form  1971-F,  it  is  permissible  to  use  the  available 
space  on  the  reverse  side  for  this  purpose. 

The  title  of  the  examiner,  on  Form  1971-E,  should  always  be 
given,  as  "A.A.S.";  " D. E.  (Designated  Examiner)";  "A. S.  (At- 
tending Specialist),"  etc. 

In  service  hospitals,  Form  1971-F  will  be  signed  by  the  officer  or 
administrative  assistant  in  charge  of  the  records  of  patients;  in 
contract  hospitals,  by  the  physician  in  charge. 

EMPLOYEES'  COMPENSATION  COMMISSION. 

SPECIMENS  OF   SUPPLEMENTARY  CASE  REPORTS. 

Subject:  Examination  and  treatment  of  Richard  Rowe. 
Reference :  Request  from  postmaster,  New  York  City. 

1.  Admitted  to  the  hospital  July  22,  1919.    Examined  by  Drs.  Maloy,  Wenner, 
and  Brown. 

2.  Complaint:  Injury  to  right  foot.    History:  While  working  in  an  elevator 
at  the  post  office,  Fifty-eighth  Street,  Brooklyn,  N.  Y.,  July  21,  1919,  at  11 
a.  m.,  patient's  right  foot  was  caught  by  an  iron  hook  of  a  truck  which  was 
being  pulled  out  of  the  elevator. 

3.  Examination,  physical :  Shows  a  contusion  and  some  signs  of  inflammation 
of  right  foot,  in  region  of  the  base  of  first  metatarsal  bone.    X-ray  of  right 
foot   is  negative  for  fracture  or  dislocation.    Photographic  prints   of  X-ray 
plates  herewith  inclosed. 

4.  Diagnosis:  Contusion    of    right    foot.    Disability:  Practically    nil.     Prog- 
nosis :  Excellent. 

5.  Comment :  Patient  discharged  August  12,  1919,  will  be  able  to  resume  full 
duty  in  one  week. 


117 

AUGUST  13,  1919. 

Subject:  Examination  and  treatment  of  John  Doe. 
Reference :  Request  from  Capt.  J.  C.  Brown,  Bush  Terminal,  Brooklyn,  N.  Y. 

1.  Admitted  to  hospital  July  14,  1919.    Examined  by  Drs.  Cady  and  York. 

2.  Complaint :  Injury  to  right  ankle.     History :  While  at  work  July  11,  1919, 
at  Pier  No.  3,  Fifty-eighth  Street,  Brooklyn,  N.  Y.,  patient  fell  from  the  top  of 
a  boxed  aeroplane,  dropping  11  feet.     Patient  received  treatment  for  his  injury 
at  the Dispensary. 

3.  Examination :  Shows   slight  ecchymosis,   swelling,   crepitation,   and   some 
preternatural  mobility  of  lower  end  of  right  tibia.    X-ray  of  right  ankle  shows 
a  comminuted  fracture  of  lower  end  of  right  tibia,  fracture  extending  into  the 
ankle  joint.     Position  good. 

4.  Diagnosis:  Fracture  about  right  ankle  joint  (simple).     Disability:  There 
will  be  total  disability  until  about  September  15,  partial  disability  until  Octo- 
ber 15,  at  least.    Prognosis :  Probably  good  for  complete  recovery,  though  there 
may  be  slight  stiffness  in  ankle,  due  to  fracture  into  the  joint. 

5.  Comment :  Patient  discharged  at  own  request  August  12  to  be  treated  as 
out-patient.    Leg  in  cast  at  present  time. 

HERNIA    CASES    ENTITLED    TO    TREATMENT    UNDER    COMPENSATION    ACT. 

The  following  rules  as  to  compensation  in  cases  of  hernia  are  in- 
tended to  serve  as  a  guide  and  can  not  be  considered  as  binding  in  all 
hernia  cases : 

1.  Predisposition  to  hernia  shall  be  regarded  as  immaterial. 

2.  Any  new  hernia,  whether  complete  or  incomplete,  resulting 
from  an  injury,  if  causing  incapacity  for  work,  shall  entitle  the 
injured  employee  to  operation  and  compensation   during  the   re- 
sulting incapacity,  but  the  evidence  must  show  with  reasonable  clear- 
ance that : 

(a)  The  alleged  hernia  was  immediately  preceded  by  some  sudden 
effort,  severe  strain,  or  the  application  of  external  force. 

(b)  The  injury  was  accompanied  or  immediately  followed  by  pain 
and  discomfort. 

(c)  The  claimant  had  no  knowledge  of  the  existence  of  the  hernia 
prior  to  the  alleged  injury. 

3.  Any  existing  hernia  which  has  not  incapacitated  for  work,  if 
materially  aggravated  as  result  of  an  injury,  is  compensable  if  caus- 
ing incapacity  for  work,  or  if  not  causing  incapacity  for  work, 
shall  entitle  the  injured  employee  to  operation  and  compensation 
during  the  resulting  incapacity,  but  the  evidence  must  show  with 
reasonable  clearness  that : 

(a)  The  alleged  hernia  was  immediately  preceded  by  some  sudden 
effort,  severe  strain,  or  the  application  of  external  force. 

(Z>)  The  injury  was  accompanied  or  immediately  followed  by  pain 
and  discomfort. 


118 

(c)  There  was  a  material  aggravation  of  the  condition  of  the 
hernia  existing  prior  to  the  alleged  injury. 

4.  In  all  cases  of  liernia  which  the  commission  shall  find  remedi- 
able by  operation,  the  claimant  shall  be  awarded  such  operation  as 
a  proper  and  necessary  part  of  medical,  surgical,  and  hospital  treat- 
ment. If  he  refuses  either  to  accept  or  to  secure  operative  treatment, 
he  shall  be  denied  further  compensation  and  treatment,  unless  there 
are  particular  circumstances  warranting  the  waiving  of  this  rule. 


INDEX. 


A. 
Abbreviations.     (See  Appendix.)  Paragraph. 

Absences,  without  leave,  of  patients 112 

Accountability  for  property.     (See  Property.) 

Acts,  persons  concerned  to  familiarize  themselves  with 24,  25 

Additional  duties,  officers  and  employees 21 

Administrative  assistant,  responsibility  of 20,  582 

Admissions : 

Clinical  records 

Comfort  of  incoming  patients 96 

Communicable  diseases 85 

Consultation  in  doubtful  cases 78,  86 

Employees  compensation  commission 409,  411—41.3 

Money  and  valuables 84 

Officer  of  the  day,  to  relieve  admitting  officer 77 

Duties  and  reports- 80,  81 

Emergency  cases 79,  84 

Patients  to  be  assigned  to  proper  wards 82 

Psychiatric  patients — 

Drug  addicts 269 

Eligibility  to  be  established 268 

Examination  within  24  hours  after  admission 281 

Relatives  to  be  informed 270 

To  be  sent  immediately  to  the  proper  ward 85 

Transfers 271. 

Records 88-91 

Of  previous  admission 111 

Responsibility  of  admitting  officer 87 

War  Risk  Insurance .—  464,  467,  468 

Admitting  officer,  duties  of.     (See  Hospital  organization  and  administra- 
tion.) 

Advance  payments,  restricted  by  law " : 714 

Advertising  for  subsistence.     (See  Subsistence,  proposals  and  contracts.) 

Aides  in  physiotherapy 258-265 

Alcohol  and  narcotics.     (See  also  Prescriptions.) 

Form  1903-B  to  be  used 139 

Head  nurse  to  keep  account  of 228 

To  keep  under  R>ck  and  key 227 

Prescription  files 137 

Property  returns  of 619 

Record  of  dispensary  receipts  and  expenditures 139 

Regulations  to  be  observed 13G 

Serial    numbers 138 

Signatures  on  prescriptions  to  be  in  ink 136 

(119) 


120 

Paragraph. 

Alien  paupers  not  eligible  for  treatment 268 

Ambulance  service 104, 105, 334 

Amusement  and  employment  of  patients 295 

Annual  Reports.     (See  Reports.) 
Apparatus,  prosthetic  and  orthopedic: 

Appliances  not  covered  by  accepted  proposal 656 

Artificial  limbs  and  eyes 429 

Officers  to  serve  best  interests  of  patient  and  Government 657 

Orthopedic  appliances 430 

Proposals  to  furnish 655 

Receipts  to  be  obtained 657 

Appendix.     (See  Pages  113-118.) 

Appliances,  prosthetic  and  orthopedic 429,430 

Arms,  artificial 422-424,  429 

Army  personnel,  officers  and  men  eligible 513 

Assistants,  dental 245 

Autopsies 197,  205,  206 

B, 

Bathing  of  patients 230, 304 

Beneficiaries,  list  of 360 

Army 360,  513 

Bureau  of -Fisheries 408 

Coast  Guard.     (See  Coast  Guard.) 

Coast  and  Geodetic  Survey 407 

Compensation   Commission.        (See  Employees   Compensation   Com- 
mission.) 

Engineer  Corps,  United  States  Army 404 

Federal  Board  for  Vocational  Education.     (See  Federal  Board  for 
Vocational  Education.) 

Foreign  seamen 514-517 

Lighthouse  Service —  405, 406 

Merchant  Marine.     (See  Seamen.) 

Mississippi  River  Commission 403 

Naval  auxiliary 513 

Navy 513 

Public  Health  Service,  field 402 

Seamen.     (See  Seamen.) 

Special  cases,  not  to  exceed  10,  etc 512 

War-risk  insurance.     (See  War-risk  insurance.) 

Between-meal  requirements 149 

Bonds  and  sureties: 

Administrative  assistants  to  furnish 20 

Contracts  for  subsistence  secured  by 658 

Formal  contracts  to  be  prepared  with —  681 

Not  required  when  quarterly  proposals  are  solicited 674 

Breach  of  discipline,  chief  nurse  to  report 213 

Buildings,  public.     (See  Custodians.) 

Bureau  of  Fisheries 408 

Burials 318-320 


121 

c. 

Paragraph. 

C-type  hospitals,  charge  of  property  in 582 

Cases : 

Doubtful 459-461 

Malingerers 443,  444 

Special,  not  to  exceed  10,  etc 512 

Certificate  of  fuel  inspection 1 713 

Change  of  diagnosis,  instructions  relative  to 185 

Charts,  dental 246 

Chauffeurs,   instructions  to 132 

Checking  of  property.     (See  Property.) 

Chief  clerk,  duties  of 7,8,10,106,107 

Chief   dietitian,    status   and   duties.       (See   Hospital    organization    and 

administration.) 

Chief  nurse.     (See  Nursing  Service.) 
Chief  of  service.     (See  Officers.) 

Civilian  employees  not  entitled,  except 561 

Clandestine  correspondence  to  be  reported 285 

Clerk,  drug 134 

Clinical  director.  (See  Officers.) 
Clinical  records.  (See  Records.) 
Clothing  of  patients.  (See  Patients.) 

Coast  and  Geodetic  Survey 407 

Coast  Guard: 

Admission  to  hospital  only  in  grave  cases ^ 395 

Authority  for  use  of  station  conveyances 401 

Commissioned  officers,  relief  same  as  in  Army 390 

On  leave,  or  sick  leave,  entitled 391 

Retired,  entitled 391 

Discharge  on  termination  of  treatment 396 

Emergency  treatment,  at  stations  of  first  class 398 

Bills  for 399 

Report  of 393 

Under  regulations  governing  fourth-class  stations 393 

Vouchers 393 

Home  treatment  of  officers 400 

Hospital  treatment  afforded  when  required ; 395 

Noncommissioned  officers  and  men,  relief  on  certificate 392 

Out-patient  treatment 397 

Relief  60  days  after  discharge 394 

Comfort  of  incoming  patients 96 

Communicable  diseases.     (See  Diseases.) 

Compensation  Commission.     (See  Employees  Compensation  Commission.) 

Complaints,  nurses.     (See  Nursing  Service.) 

Conduct  of  personnel  in  isolation  wards •   169 

Conjoint  direction  of  District  supervisors 42 

Consular  officer,  valuables  to  be  delivered  to 317 

Contracts  for  subsistence.     (See  Subsistence,  proposals  and  contracts.) 

Contract  hospitals,  authorized  rate  in ,_  39 

Convalescent  patients,  light  duty 200,  462 

Cooperation  with  District  supervisors : 34,  35 


122 

Paragraph. 

Corrections  In  regulations,  authorized 26 

Correspon  deuce : 

Federal  Board  for  Vocational  Education 519 

Third  and  fourth  class  stations- 36,37 

War  risk  insurance , 508-511 

Cross  infection,  prevention  of -  171 

Cultures - 170 

Custodians : 

Advance  payments  for  services , 714 

Authority  necessary  to  change  fences,  etc 710 

Certificate  of  inspection  of  fuel 713 

Diagrams  of  buildings '. 705 

Economy  in  use  of  gas,  light,  and  water 712 

Fire  control 715-720 

Furniture,  list  of,  in  quarters ; 708 

"  Instructions  to  Custodians  of  Public  Buildings  " „ 703 

Leases,  application  for  renewal  of 711 

Medical  officer  in  charge,  ex  officio 702 

Official  to  serve  during  absence 704 

Repairs  to  property : 639 

Reports  of  necessary  repairs 709 

Rooms  to  be  used  for  official  purposes 707 

Trespass  and  destruction  of  property,  prevention  of 706 

Custody  of  valuables.     (See  Valuables.) 

Customs   officer . 321-324 

Custody  of  property 584 

D. 

Death  certificates 198 

Deceased  patients.     (See  Patients.) 

Dental  assistants . 245 

Officers,  duties.     (See  Officers.) 

Records.     (See  Records.) 

Service.     (See  also  War  risk  insurance.) 

Charts - 246 

Commissioned  dental  officers 575 

Duties  of  assistant  to  chief 245 

Personnel,  described 243 

Records,  to  be  complete 247 

Disposition  of ^ : 248 

Responsibility  of  dental  officers 244 

Surgical  treatment _ ' —  428 

Destruction  of  property.     (See  Property.) 

Diagnosis,  change  of,  instructions  relative  to 185 

Negative , 443,444 

Diagrams   of  buildings 705 

Dietetic  Service.     (See  Hospital  organization  and  administration.) 

Diets.     (See  Hospital  organization  and  administration.) 

Diphtheria,  isolation  of_ 170, 171 

Discharges.     (See  Patients.) 

Discipline  of  patients 309-313 


123 

Diseases,  communicable:  Pai-agraph. 

Cross  infection,  prevention  of 171 

Cultures 17° 

Discharges  and  transfers 93 

Disinfection  of  kitchen  equipment , 150 

Clothing,  patients,  personnel  and  wards 168 

Examination   of   employees 151 

Incoming  patients . 85 

Observation  room  for . 07 

Patients  not  to  handle  food,  dishes,  etc.,  used  by  other  patients 172 

Personnel  in  isolation  wards 169 

Not  to  be  detailed  to  surgical  cases  within  10  days 170 

Venereal,  segregation  of 180 

Eligibility  for  treatment '_ 466 

Visitors  with,  denied  admittance  to  .hospital , 101 

Dishes,  food  containers,  etc.,  in  isolation  wards 168, 172 

Disinfection  of  kitchen  equipment 150 

Patients 168 

Rooms 168 

Dispensary,  charge  of 134 

Dispensing,  economy  to  be  exercised  in 199 

Disposal  of  property.     (See  Property.) 
District  examiner.     (See  District  supervisors.) 

Relief  officer.     (See  District  supervisors.) 
District  supervisors: 

Bills  for  examinations,  statement  to  be  placed  on 45 

Conjoint  direction  of 42 

Cooperation  with,  by  service  officers 34,  35 

District  examiner 43 

Relief  officer 44 

Division  into  districts 32 

Field  representatives  of 41 

Function  of  Public  Health  Service 42 

War  Risk  Insurance 42 

General  duties 33 

Hospital  centers 54-58 

Records 46 

Report  cards 47 

Reports 48-52 

£tate  supervisors 53 

Third  and  fourth  class  stations  under  direct  supervision 86,37 

To  keep  record  of  available  facilities . 38 

Doubtful  cases.     (See  Employees  Compensation  Commission.) 

Drug  addicts,  treatment  of : 269 

Drug  clerk 1 134 

Duties  of  dietitians.     (See  Hospital  organization  and  administration.) 
Nurses.     (See  Nursing  Service.) 
Officers  .   (See  Officers.) 

E. 

Economy  in  use  of  gas,  light,  and  water 712 

Efficiency  reports,  nurses 218,226 

Personnel 161 


124 

Emergency  purchases.     (Ree  Special  requisitions  anil  purchases.)          Paragraph. 
Treatment 84 

Employees,  responsibilities  and  duties: 

Additional  duties '. 21 

Ambulance   drivers 104, 105 

Assistants  to  head  nurse  in  wards 209,223 

Bathing  of  patients 304 

Carriers  of  diseases 151 

Chauffeurs 132 

Chief  dietitian,  authority  over 153 

Complaints  of 353 

Confidential  duties 283 

Dereliction  of  duty 9,  293 

Discipline  of,  in  hospital  mess 150 

Economy  in  use  of  lights  and  water 712 

Exercise  of  patients 290, 291 

Fires,  vigilance  with  regard  to i__  74,303 

Flag  ceremonies 1 

Forced  feeding  not  permitted,  except 294 

Fuel  supplies 713 

Hospital  postoffice 126, 127 

Illness  of,  in  hospital 194 

Information   clerk 91 

Instruction  of,  by  chief  nurse 1 212 

:  Isolation  wards '_ 168, 170 

Kitchen  and  dining  room,  examination  of 151 

Laundry 140, 144 

Medical  officer  in  charge  responsible  for 62 

Mess 145 

Observation  room 97 

Patients  not  permitted  to  work  on  wards  without  presence  of 297 

Not  to  be  left  alone  in  wards ' 292 

Permission  to  leave  reservation 11 

Place  of  duty  of  ward  employees 298, 299 

Property,  responsible  for  misuse  of 592,593 

Restraint 296 

Roster  of 66 

Station  office  not  to  be  left  without 10 

Storekeeper 148 

Supplies,   checking  of 147 

Testimonials  of  character 12 

To  be  informed  of  dangerous  patients 281 

To  notify  admitting  officer 96 

To  notify  officer  of  the  day : 79 

To  remain  with  patients  during  meals 301 

To  retain  charge  of  patients 295 

Weapons,  patients  not  to  possess . 289 

Employees  Compensation  Commission.     (See  also  Appendix.) 

Act,   section  9 410 

Admission 409,411-413 

Appliances,  prosthetic  and  orthopedic 429,430 

Arms,  artificial 422-424, 429 

Convalescents,  light  work  for 462 


125 

Employees  Compensation  Commission — Continued.  Paragraph. 

Dental  surgical  treatment 428 

Doubtful  cases 459-461 

Expenditures  for 414-418 

Eyes,  artificial 425-427 

Hernia  (see  also  Appendix) 455-458 

Home  treatment 1 441 

Insane,   transfers  of , 463 

Limbs,   artificial 419-424,  429 

Negative  diagnosis 443-445 

Orthopedic  appliances 430 

Photographs  to  be  made 438, 448,  452-454 

Records 462 

Reports   (see  also  Appendix) 431-437,456 

Specialists,  services  of 439,  446,  447 

Teeth 428 

Transfers,  of  patients 440 

X-ray 447-451 

Empyema,  isolation  of 171 

Enforcement  of  regulations.     (See  Regulations.) 

Engineer  Corps 404 

Erysipelas,  isolation  of 170, 171 

Escape  of  insane.     (See  Neuro-psychiatric  patients.) 

Estimates  of  subsistence.     (See  Subsistence.) 

Repairs,  reported  by  custodian __      709 

Examinations  of  employees 151 

Federal  Board 526-530 

Lighthouse  Service 406 

War  Risk  Insurance 469-472,  474,  526 

Exchange  of  unserviceable  property.     (See  Property.) 

Supplies,  prohibited . _ 580 

Executive  officer,  duties  of.     (See  Officers.) 

Exercise  of  insane.     (See  Neuro-psychiatric  patients.) 

Exigency  purchases.     (See  Special  requisitions  and  purchases.) 

Expendable  property.    (See  Property.) 

Expenditures,  additional,  authority  for : 700 

Compensation  Commission.     (See  Employees  Compensation  Commis- 
sion.) 
Federal  Board.     (See  Federal  Board  for  Vocational  Education.) 

Eye,  ear,  nose  and  throat  department 173, 178 

Eyes,  artificial 425-427 

F. 

False  impressions  of  patients  to  be  checked 284 

Federal  Board  for  Vocational  Education : 

Correspondence,   direct 519 

Discharges 540 

Examinations 520-530,541 

Forms  to  be  used 542,  543 

Organization,  district,  to  correspond  to  Public  Health  Service  and 
War  Risk  Insurance -      518 


126 

Federal  Board  for  Vocational  Education — Continued.  Paragraph. 

Training 531,  532 

Charges  for 533-538 

Conferences 539 

Observation,  daily 545 

Passes 544 

Federal  Employees.     (See  Employees  Compensation  Corn-mission.) 
Female  patients.     (See  Patients.) 

Field  personnel,  Public  Health  Service,  entitled 402 

Field  representatives.     (See  District  supervisors.) 
Fire,  regulations,  apparatus,  etc. : 

Custodian  in  charge  of  equipment 715 

Head  nurse  to  assemble  patients  in  hall 303 

Inspection  of  hazards 354 

Instructions  to  employees  in  winter 74 

Regulations 716-720 

Flag,  display  of 1,2,19 

Food  supplies - 145-150 

Forced  feeding  and  medication 294 

Forms,  blank _ 633,  634 

Formulae,  sanctioned  only  by  medical  officer  in  charge 15 

Foreign  seamen 514-517,  561 

Fourth-class  stations 557-561 

Fuel,  and  bills  for 712,  713 

Function  of  Public  Health  Service 42 

War  Bisk  Insurance 42 

Furniture,  list  of,  in  quarters 708 

G. 

Garage,  employee  in  charge  of 131 

Gasoline  consumption 132 

Gossip  forbidden 283 

Grounds,  policing  of _ 130 

H. 

Hair  cutting 305 

Head  nurses,  duties.     (See  Nursing  Service.) 

Hernia  (see  also  Appendix) 455-458 

Holidays,  legal 16-18 

Home  treatment,  Coast  Guard 400 

Employees'  Compensation  Commission 441 

Field  service 402 

Seamen __ 547 

Hospitals,  classification  of 29 

Contracts  with 39 

Hospital  centers  or  units 54-58 

Hospital  organization  and  administration : 

Administrative  plans  of  type  A,  B,  and  C  hospitals 60 

Admitting  officer — 

Ambulances,  supervision  of 104, 105 

Card  index  in  office 88-92,96 

Clinical  record,  preparation  of 83 

Comfort  of  incoming  patients 96 


127 

Hospital  organization  and  administration — Continued. 

Admitting  officer — Continued.  Paragraph. 

Communicable  diseases,  observation  room  for 97 

Discharges  and  transfers 93, 191 

Doubtful  cases 86 

Examination  of  incoming  patients 82,  85 

Registrar  to  be  notified  before  discharge  of  patients 95 

Responsible  for  care  and  treatment,  until 87 

To  be  notified  of  impending  discharge 94 

Valuables  of  patients,  receipt  and  delivery  of 84, 122 

Visitors *. 88-103 

Chief  clerk,  duties  of 106, 107 

Dental  Service.     (See  also  War  Risk  Insurance.) 

Charts 246 

Duties  of  assistant  to  chief 245 

Personnel,  described 243 

Records,  to  be  complete 247 

Disposition  of 248 

Responsibility  of  dental  officers 244 

Dietetic  Service — 

Between-meal  requirements,  24-hour  supplies  only 149 

Breach  of  discipline,  to  be  reported  by  chief  nurse 213. 

Checking  and  recording  of  supplies 147, 148 

Chief  dietitian,  cooperation  with  nurses 215 

Cooperation  with  Nursing  Service 152-154, 156 

Dietitian,  responsibility  and  authority 146, 150, 153-155 

Diets 168,  186,  236-238 

Examination  of  kitchen  and  dining-room  employees 151 

Food  supplies 145-150 

Medical  officer  in  charge  to  maintain  constant  supervision 145 

Menus  to  be  submitted  to  medical  officer  in  charge 154 

Ration  report 152 

Status  of  dietitians 157 

Executive  officer,  responsibilities  and  duties.     (See  Officers.) 

Eye,  ear,  nose,  and  throat  department  in  type  A  hospitals 178 

Isolation  wards — 

Conduct  of  officers,  nurses,  and  employees 169 

Diets 168 

Disinfection,  of  clothing 168 

.  Patients  and  personnel 168 

Wards 168 

Handling  of  dishes  and  food  containers 168 

Nurses  and  attendants  not  to  be  detailed  to  surgical  cases  within 

10  days 170 

Patients  not  to  handle  food,  dishes,  etc.,  used  by  other  patients 172 

Prevention  of  cross  infection 171 

Segregation  of  nurses  and  employees 168 

Laboratory  Service — 

Autopsy,  reports  of  findings 206 

Chief,  in  type  A  hospitals 203 

Examination  of  specimens ^ 204 

Pathologist 205 

Post-mortems,  duty  of  officers  to  be  present 207 

X-ray  'section 208 


128 

Hospital  organization  and  administration — Continued. 

Materiel  officer  in  type  A  and  B  hospitals—  Paragraph. 

Alcohol  and  narcotics 136 

Charge  and  care  of 131-133 

Dispensary 134 

Duties  of 130 

Laundry    supervision 140-144 

Prescriptions,  to  be  numbered  and  filed 137-139 

To  be  signed  by  medical  officer 135 

Property,  charge  of , 581 

Medical    officer    in    charge,    responsibilities    and    duties    (see   also 
Officers) 61-64 

Medical  Service 165 

Neuropsychiatric  ward ; 167 

Nursing  Service  (see  also  Nursing  Service) 210-242 

Officer  of  the  day — 

Disposition  of  bodies 76 

Doubtful  cases 78 

Duties  of 80 

Emergency  sick  calls 79 

Instructions  to  employees ^ 74 

Inspections 71-73 

Notification  to  relatives '. 75 

Not  to  leave  hospital,  except 70 

Relief  of,  by  admitting  officer 77 

Reports 81 

Tour  of  duty 69 

Valuables 123 

Personnel  officer,  type  A  hospitals 108 

Professional  services — 

Attending  specialists,  to  be  utilized  in  type  B  and  C  hospitals—      164 

Chiefs  of  service 161,162 

Clinical  directors 161, 162 

Communications,  in  type  A  hospitals 163 

Type  A  hospitals _" 158 

Type  B  hospitals 159 

Type  C  hospitals 160 

Reconstruction  service — 

Aides,    chief 258 

In  physiotherapy 260 

Head,  in  physiotherapy . 259 

Pupil,  in  physiotherapy 261 

Head,  in  occupational  therapy 263 

In  occupational  therapy 264 

Pupil,  in  occupational  therapy 265 

Employees,  special 262 

Instructors,  special 257 

Reconstruction  officer,  duties 252-256 

Scope  of  service 249-251 

Registrar,  in  type  A  hospitals — 

Absences  of  patients  without  leave 112 

Clinical  records 114 


129 

Hospital  organization  and  administration — Continued. 

Registrar,  in  type  A  hospitals — Continued.  Paragraph. 

Custody  of  valuables 109 

Duties  of I09 

Forwarding  address 128 

Information  relative  to  disease  of  patients 113 

Inquiries  to  be  referred  to 109 

Leave  of  absence 124 

Mail  125-127 

Notification  to  relatives 110   ' 

Patients'  property 116-121 

Records  of  patients : 111 

Transfer  of  responsibility : 124 

Valuables  of  patients —  115, 122 

Surgical  Service — 

Chief  of  service,  responsibility 173, 174 

Officers  not  to  take  part  in  post-mortems 175 

Operating  room  to  be  always  open 177 

Written  consent  to  be  obtained  for  operation 176 

Tuberculosis  ward 166 

Type  A  hospitals,  purpose  of 59 

Urology,  in  type  A  hospitals 179, 180 

Segregation  of  venereal  diseases 180 

Sterilization   of   dishes 180 

Ward  employees.     (See  Employees.) 
Ward  surgeons.     (See  also  Officers.) 

Authority  to  be  secured  for  transfer  of  patients 191 

Autopsy,   authorization   for 197 

Clinical  records.     (See  also  Records.) 

Accuracy  and   conciseness 184 

Completion  of '_ 189 

Not  to  be  removed  from  ward 190 

Time  of  first  examination  to  be  noted 182 

To  accompany  patients  before  boards 187 

To  accompany  patients  transferred 188 

Daily  reports  of  patients 193, 195 

Deaths,  notification  to  Officer  of  the  Day 196 

Death  certificates 198 

Diagnosis,  change  of 185 

Diets 186 

puties  of 181 

Examination  of  patients 182 

Illness  of  personnel 194 

Passes  : 201 

Patients,  convalescent,  light  duty 200 

Prescriptions,   economy  in 199 

Service  property.     (See  Property.) 

Transfers,  between  wards 188, 192 

Valuables , 183 

Hours  of  duty,  nurses.     (See  Nursing  Service.) 
185279°— 20 9 


I. 

Illness  of  nurses.     (See  Nursing  Service.)  Paragraph. 

Personnel   ^ 194 

Information  relative  to  disease  of  patients 113 

In-patient  relief.     (See  also  Relief.) 

Dental  treatment,  by  commissioned  officers 575 

Fourth-class    stations < 573 

Register 569,  570 

Reports 566,567 

Transfers  of  patients 568 

Insane.     (See  Neuro-psychiatric  patients.) 
Inspections : 

By  medical  officer  in  charge 356-359 

Fire    hazards 354 

Of  goods   received 651 

Of  relief  stations — 

Commissioned  officers  to  inspect 335,336 

Complaints 1 353 

Emergency  action,  by  telegraph 346 

Examination  of  all  station  activities 340 

Fire  hazards,   requirements 354,  355 

Infraction  of  service  regulations 341 

Method   of  procedure 339 

Personal  inspection  by  officer 338,  349 

Recommendations  to  medical  officer  in  charge 342,  343 

Reports 344-348 

Requisitions : 351 

Special  orders  for 337 

Supplies  on  hand 352 

Unserviceable   property 1 350 

"  Instructions  to  Custodians  of  Public  Property  " 703 

Instructors,  special,  in  physiotherapy _ 257 

Isolation   wards - 168-172 

Issue  of  property,  by  materiel  officer 585 

J. 

Junior  officers  not  to  leave  station  without  consent 


K. 

Keys,  custody  of 13 

L. 

Laboratories 203-208 

Chief,  l»-t£pe  A  hospitals— 203 

Examinations 204 

Laundry — - 130,  140-144,  229 

Laws,  persons  concerned  to  be  ftimiliar  with 24,  25 

Leases 686,  687,  711 

Lighthouse  Service 405, 406 

Lights,  economy  in  use  of 712 


131 

Paragraph. 

Limbs,  artificial 419, 424,  429 

Liuen,  disposition  of . '  229,  233 

Live  stock 606 

Locator  cards 88-92 

Loss  of  property.     (See  Property.) 

M. 

Mail,  method  of  handling 125-128 

Male  nurses.     (See  Nursing  service.) 

Malingerers 443,  444 

Marine  hospitals,  types  of 29 

Materiel  officer.     (See  Hospital  organization  and  administration.) 
Medical  officer  in  charge.     (See  Officers.) 
Medical  officers,  general,  duties.     (See  Officers.) 

Medical  Service 165 

Medical  and  surgical  supplies: 

Medical  officers  to  report  defects  in 653 

Property   return   of   microscopes   and   accessories   in   possession   of 

officers 654 

Supply  table 652 

Medicines,  vouchers  for.     (See  Vouchers.) 
Memorandum  receipts.     (See  Receipts.) 

Meningitis 170,  171 

Mental  defectives,  treatment  of 269 

Merchant  marine.     (See  Seamen.) 

Messes,  supervision  and  regulation  of 145-147, 168 

Mess   attendants 150, 151 

Mississippi  River  Commission . 403 

Morale ,- 251 

Morgue 76,  205 

N. 

Narcotics.     (See  Alcohol  and  narcotics.) 

Naval  auxiliary 513 

Navy,  personnel  entitled  to  treatment 513 

Negative  diagnosis,  Compensation  Commission 443-445 

Neuro-psychiatric  officers.     (See  Officers.) 
Neuro-psychiatric  patients : 

Admission,  care  to  be  exercised  in 268 

•     Rules  governing 266 

Amusement  and  employment 295 

Bathing 1 304 

Care  to  be  exercised  In  dining  room 301 

Clandestine  correspondence,  reporting  of 285 

Clinical  director,  duties 280 

Consent  of  relatives  to  be  obtained 270 

Dangerous  articles,  not  to  possess 287 

Detail  work,  assigning  of 286 

Drug  addicts  and  mental  defectives 269 

Employees'  Compensation  Commission 463 

Escapes 290,293 


132 

Neuro-psychlatric  patients — Continued.  Paragraph. 

Exercise  of ____ . 290,  291 

False  impressions  to  be  checked 284 

Forced    feeding 294 

Fire 302,  303 

Gossip  about  patients  forbidden 283 

Guarding  and  searching  of 289 

Hair    cutting : 305 

Not  permitted  to  aid  one  another '. 300 

Not  to  be  left  alone  in  ward 292,  297 

Nurses — 

Amusement  for  patients 295 

Duties  of,  confidential _- 283 

Escapes,  to  be  considered  negligence 293 

Forced  feeding,  not  permitted,  except 294 

Head  nurse,  duties ."___      303 

Night  nurses—- 307 

Night  supervising  nurse • 308 

Nonparole  patients  to  be  exercised 290 

To  be  guarded  from  strangers 291 

Patients  not  allowed  to  be  in  ward  without  nurse 292 

Patients  to  be  properly  clothed  for  visitors 299 

Restraint 296 

To  remain  in  dining  room  during  meals 301 

To  report  presence  of  strangers 300 

Obscene  allusions  to  be  suppressed J. 284 

Organization  of  hospital  to  conform  to 278,279 

Paroles  and  discharges 274-277 

Peripheral  nerve  injuries,  study  of .      273 

Reassurances  to  patients 288 

Restraint  of —      296 

"  Shell  shock  " — term  not  to  be  used 272 

Temporary  care  in  observation  ward 267 

Transfers : 271, 332,  333 

Visitors 299, 300 

Ward  employees,  duties -. 298 

Surgeons,  duties , 281,  282,  286 

Neuro-psychiatric  wards 167 

Night  supervising  nurse —       308 

Nomenclature  of  diseases  and  conditions 476 

Nursing  Service: 

Chief    nurses 210-219 

Complaints,  to  be  transmitted. through  chief  nurse 214 

Duties,  general 239-242 

Efficiency  reports  __.  .—  218,  226 

Head  nurses: 

Clothing  of  patients,  to  care  for 183 

Diets  to  be  noted  on  clinical  record 186 

General  duties 229-237 

To  assemble  patients  in  hall  in  case  of  fire 303 

Hours  of  duty - 239 

Illness 216 

Male  nurses 209 


133 

Nursing  Service — Continued. 

Neii re-psychiatric.     (See  Neuro-psychiatric  patients.)  Paragraph. 

Night  nurses 219-221,  240 

Night  supervisor : 219-221 

Quarters 213 

Resignations 214 

Responsible  for  property  in  immediate  possession 592 

Segregation,  isolation  in  wards 168 

O. 

Obscene  allusions  to  be  suppressed 284 

Observation  room  for  patients 97 

Obsolete  books 615 

Occupational  therapy 250,  262-265 

Officer  of  the  day.     (See  Hospital  organization  and  administration.) 
Officers,  responsibilities  and  duties: 

Admitting  officer.     (See  Hospital  organization  and  administration.) 

Chief  of  laboratory  service,  type  A  hospitals*. 203 

Chief  of  service — 

Assistant  to  medical  officer  in  charge 162 

Clinical  records 189, 190 

Communications  in  type  A  hospitals 163 

Consultant,  general 164 

Surgical 174 

Departments  under  supervision  of,  in  type  A  hospitals 158 

Permission  to  enter  isolation  wards 169 

Personnel  of  medical  service 165 

Surgical  service 173 

Responsibilities  of 161 

Transfers 192 

Clinical  director — 

.     Assistant  to  medical  officer  in  charge 162,  280 

Clinical  records 296 

Professional  work  under  supervision  of,  in  type  B  hospitals 159 

Responsibilities  of 161 

Consular  officer,  valuables  to  be  delivered  to 317 

Customs  officer 321-324 

Dental  officers — 

Assigned  to  contract  hospitals 480 

.       Each  hospital  of  the  service 478 

Each  out-patient  office  of  the  service 479 

District  treatment  under  direction  of  district  supervisor 477 

Examiners  on  fee  basis 4S1-484 

Treatment  by  commissioned  dental  officers 575 

Type  A  hospitals 243-248 

District  examiners.     (See  District  supervisors.) 
Relief  officers.     (See  District  supervisors.) 
Supervisors.     (See  District  supecvisors.) 
Executive  officer — 

Communications,  in  type  A  hospitals 163 

Junior  officers,  not  to  leave  station  without  consent 4 

Responsibilities,  in  type  A  and  B  hospitals 65-67 


134 

Officers,  responsibilities  and  duties — Continued. 

General  medical —  Paragraph. 

Accountable  for  property- 612 

Acts,  to  be  familiar  with , 24 

Additional   duties 21 

Contracts  for  over  $100 683 

Cooperation  with  district  .supervisors 34,  35 

Deceased  patients  not  to  be  moved  until  pronounced  dead 314 

Dereliction  of  duty,  employees 9 

Discussion  with  patients  prohibited 472 

Inspection  of  bodies 315 

Inspector  to  be  accompanied  by - ,_^ 604 

Junior  officers  not  to  leave  station  without  consent 4 

List,  alcohol  and  narcotics 619 

Morning  rounds,  reports  of 3 

Not  required  to  visit  seamen  on  vessels,  except 564 

Patients  to  be  informed  of  necessary  procedure  on  admission  to 

hospital i w 470 

Post-mortems,  officers  to  :be  present ^ 207 

Surgical  staff  not  to  take  part  in 175 

Prohibited  from  visiting  isolation  wards  when  off  duty ' 169 

Prompt   discharge   from   contract   hospitals   at   -termination   of 

treatment 563 

Property  not  to  be  purchased  by  condemning  officer ! 610 

Receiving  officers  to  be  notified  of  patients'  arrival 334 

Regulations,  changes  in  to  be  noted *. 27 

Enforcement  of ,».. ,___ 25 

Rules  for  departure  from  and  return  to  station 5 

Station  not  to  be  without  officer •. 8 

Transfer  of  supplies  and  equipment - 622 

Materiel  officer.     (See  Hospital  organization  and  a^miinrstratioti.) 
Medical  officer  in  charge — 

Anticipation  of  six  months'  needs .     631 

Bidders  to  submit  samples— ,_^-— .— _^ ___  665 

Custody  of  keys . 13 

Property  at  second  and  third  class  stations ____• 583 

Departure  from  and  return  to  station 6 

Details  officers , , . _ 68 

Designation  of  necessary  labor  on  holidays , 16 

Duties  and   responsibilities 61-64 

Employees  to  obtain  permission  to  leave  station 11 

Equipment  requisitions  to  be  signed  by * 585 

Escapes  to  be  reported 293 

Examination  of  Federal  Board  patients . 541 

Immediate  supervision  in  type  C  hospitals -. . . , 160 

Inspections  of  station __^~ ^^ ,_. 356-359 

Instructions  to  officer  of  the  day :___  69 

Notification  of  transfer . + 271 

Officers  to  obtain  consent  to  ieave  station 4 

Overseeing  of  patients  to  be  paroled ._. 277 

Prosthetic   appliances,   proposals—— *» 655 

Rejection  of  inferior  supplies _-„ ,_^__  685 


135 

Officers,  responsibilities  and  duties — Continued. 

Medical  officer  in  charge — Continued.  Paragraph. 

Reports,  by  chief  nurse 213-218 

Of  paroled  patients 275 

Specialist  to  be  obtained  by 453 

Submission  of  menu  by  chief  dietitian 154 

Subsistence  supplies  at  contract  rates 682 

Supervision  of  mess , 145 

State  holidays 17 

Testimonials  of  character  given  by 12 

Neuro-psychiatric  officers 167,  280-282 

Officer  of  the  day.     (See  Hospital  organization  and  administration.) 

Pathologist 205 

Personnel  officer__ 108,194 

Reconstruction  officer.     (See  Hospital  organization  and  administra- 
tion.) 

Registrar,   in    type   A   hospitals.      (See   Hospital   organization    and 
administration.) 

Roentgenologist 208 

Specialists 439,  445,  440 

Compensation  Commission 458 

For    diagnosis 458 

Local  physicians  in  type  B  and  C  hospitals 164 

State  supervisors.     (See  District  supervisors.) 

Tuberculosis    officer 16G 

Ward  surgeon.      (See  also  Hospital  organization  and  administration.) 

Assigns   patients   work 286 

Diet  slip,  to  sign 237 

Emergency 238 

Disinfection  of  rooms 168 

.Employees  to  be  informed  of  dangerous  patients 281 

Exercise  of  nonparole  patients 290 

Head  nurse,  to  assist 233 

To  receive  orders  from 224 

To  report  valuables  in  possession  of  patients .  221. 

Hair  cutting 305 

Isolation  wards 169 

Permission  for  employees  to  leave  ward 298 

Property,  responsibility  for 585 

Recreation  for  patients 282 

•  Responsible,  in  emergency,  for  patients'  effects 120 

Restraint  of  insane 296 

Verification  of  drug  record , 228 

Oil  and  gasoline,  account  of 132 

Open-market  purchases 671 

Operating  room,  to  be  always  available 177 

Operation,  written  consent  to  be  obtained  for 176 

Orders,  written,  from  ward  surgeon 224 

Organization.     (See  Hospital  organization  and  administration.) 

Orthopedic  apparatus  and  appliances 430 

Out-patient  relief.     (See  Relief.) 


136 
p. 

Paroles  and  discharges.     (See  Neuro-psychiatric  patients.)  Paragraph. 

Passes 201 

Pathologist 205 

Patients : 

Absence  of 112 

Alien  paupers 268 

Clothing,  care  of 183 

Disinfection  of 1GS 

Consent,  written,  to  be  obtained  for  operation 176 

Contract 39. 

Convalescent,  light  duty  for 200 

Deceased —  . 

Autopsies 197, 205,  206 

Bodies,  disposition  of : 314 

Examination  of,  by  officer  of  the  day 16 

Inspection  of 315 

Burial  expenditures 318 

Death  certificates,  local 198 

Disposition   of  effects 118 

Nonbeneficiaries,  disposition  of 320 

Notification  to  officer  of  the  day 196 

Official  message  to  relatives 75, 193 

Record,  referred  to  officer  in  charge  of  clinical  records 189 

Report,   to  medical  officer 162 

Of  ward  surgeon • 185 

Transportation  regulations 319 

Valuables 316 

Of  seamen 317,  321-324 

War-risk  insurance -—i 318,  319 

Discharges — 

Advance  notification,  to  admitting  officer 94 

To  registrar 95 

At  own  request 312 

Clinical  record,  completion  of 189 

Inspection  of 93 

Locator  card  to  be  destroyed _ 92 

Neuro-psychiatric 276,  277 

Discipline 309-313 

Disinfection  of 168 

Drug  addicts 269 

Female 333 

Ineligible  for  treatment 465 

Information  relative  to  diseases  of 113 

Insane.     (See  Neuro-psychiatric  patients.) 

Mental   defectives 269 

Passes . 201 

Property — 

Disinfection 168 

Form  1971-J,  preparation  of 117 

Patients'  property  slips 232 

Responsibility  for 116 

Ward  surgeon  to  deliver 183 


137 

> 

Patients — Continued.  Paragraph. 

Public  Health  Service,  field 402 

Register  of.     (See  Appendix.) 
Seamen.     (See  Seamen.) 

To  include  war-risk  patients 40 

Transportation- 
Authorization   for 325 

Officers  to  notify  in  advance,  of  transfer 334 

Neuro-psychiatric 332,  333 

Requests    for 326-328 

Travel  expense,  war-risk  insurance 329 

Public  Health  Service . 330 

Persons  leaving  hospital  contrary  to  advice 331 

Valuables — 

Admitting  officer,  to  deliver  to  patients  at  departure 93 

To  notify  registrar  on  departure  of  patients 95 

Bond  to  be  furnished 20 

Collection  and  delivery  of,  at  death 76 

Custody  of  during  absence  of  regular  officer : 122-124 

Discovery  of,  in  possession  of  patients 231 

Emergency  cases,  ward  surgeons  to  be  responsible 120, 183 

Forwarding  to  relatives 316 

Immediate  delivery  to  responsible  officer  at  time  of  admission__  84 

Registrar,  in  type  A  hospitals,  responsible 109 

To  be  deposited  in  safe 115 

Venereal  diseases 180, 466 

War  risk  insurance — 

Autopsy  findings,  one  copy  to  chief  medical  adviser 206 

Beneficiaries,  classes  of 464 

Blank  form  No.  526,  use  of 467 

Chief  medical  adviser  to  be  kept  informed 1 23 

Dental  treatment.     (See  War  risk  insurance.) 

Discussions  between  examiner  and  patient  prohibited 472 

District  treatment,  of 473 

Examination,  after  presentation  of  discharge  dated  on  or  after 

April  6,  1917 471 

Examinations  to  be  complete 469 

Function  of  Public  Health  Service : 42 

War  risk  insurance 42 

Hospital  treatment  to  be  in  residence  district,  except 473 

Hospital  treatment  not  solicited 470 

Limitations  of  term  "  patients  of  Bureau  of  War  Risk  Insur- 
ance " 464 

Nomenclature  of  diseases  and  conditions,  to  be  referred  to 476 

Out-patient  relief 468 

Persons  not  entitled 465 

Record  cards 46,  47 

Reports,  annual 52 

To  be  comprehensive 475 

Weekly  and  monthly 48-51 

Written,  of  examinations 474 

Statement  on  bills  for  examinations 45 

To  be  included  as  Public  Health  Service  patients 40 

Venereal  diseases 466 


13S 

Paragraph. 
Peripheral  nerve  injuries,  study  of.     (See  Neuro-psychiatric  patients.) 

Personnel  officer 108 

Illness  of 194 

Photographs 438.  447,  451-455 

Physiotherapy 250,  253,  259-262 

Policing  of  grounds 130, 132 

Post-mortem  examinations . . 175,  207 

Post  office . 125-128 

Prescriptions.     (See  also  Alcohol  and  narcotics.) 

Alcohol  and  drug,  to  be  signed  in  ink 136 

Current  prices  to  be  charged 695 

( Designated  examiner  to  give  -prescription  in  case  of  necessity 468 

Economy  to  be  exercised  in  filling 199 

Files  for 137 

Inspection  of  prescription  files 138 

Signature  of  medical  officer  on  Form  1921-A  necessary 135 

Vouchers  for 468,  696 

War-risk  insurance 468 

Private  sale  of  property  prohibited 579 

Prophylactic  dental  treatment 492 

Property : 

Accountability  for — 

Administrative  assistant  accountable  in  type  C  hospitals 582 

Authority  to  drop  from  return 614 

Customs  officer  accountable  at  stations  where  no  officer  is  on 

duty. 584 

Definition  of 576,  577 

Exchange  with  druggists  prohibited 580 

Expendable 612,  614 

Materiel  officer  accountable  in  type  A  and  B  haspitals 581 

Medical  officer  in  charge  accountable  at  third  and  fourth  class 

stations 583 

Obsolete 615 

Officers  to  take  up  and  account  for  on  returns 612 

Preparation  of  requisitions,  invoices,  and  receipts- 578 

Private  sale  prohibited _ 579 

Property  must  be  on  hand  to  be  accounted  for 613 

Loss  or  destruction  of — 

Causes 594 

Board  of  survey 595 

Patients'.     (See  Patients.) 
Requisitions- 
Dates  for  forwarding  semiannual  from  districts 627 

Emergencies 629 

Officers  to  request  only  what  is  actually  needed 630 

To  request  six  months'  supply  only 631,  632 

Official  supply  table,  to  be  standard „ 628 

Stationery  and  blank  forms fc 633,  634 

Responsibility  for — 

Monthly  exchange  of  memorandum  receipts . 586,  587 

Curses  and  employees   responsible  f«r  property   in  immediate 

592 


139 

Property— Continued. 

Responsibility  for — Continued.  Paragraph. 

Supervision  to  prevent  misuse 593 

Transfers  of  responsibility 588,  589 

Unauthorized  transfers 590,  591 

Ward    surgeons     responsible    for    property    under    their    im- 
mediate charge 585 

Returns — 

Expendable 620 

Instructions  for  making 617 

Monthly  and  semiannual  lists  on  Form  9203-C 619,  620 

Semiannual 616 

Stock,  count  of,  in  storeroom , 621 

Vouchers 618 

Transfers  of,  between  accountable  officers — 

Care  to  be  taken  in  ascertaining  contents  of  wises 623 

Instructions  for  making 622 

Inventories 626 

Medical  property , 625 

Serial    numbers    of    microscopes,    safes,    etc.,    to    .be    entered 

on  invoices 624 

Unserviceable — 

Arrangement  for  Inspection 601 

Articles  that  can  be  repaired  not  to  be  recommended  for  sale ,_  607 

Care  and  preservation 599 

Condemned,  not  to  be  purchased  by  condemning  officer 610 

Not  to  be  resubmitted  for  inspection 609 

Exchange  Klips 597 

Inventories —  600 

Live  stock,  killing  of 606 

Miscellaneous  receipts 611 

Not  to  be  condemned  if  still  serviceable 605 

Officer  to  accompany  inspector 604 

Reports  of  condition  and  recommendation  for  disposal 598 

Of  inspection - 608 

Retention  of  articles  to  be  used  in  cleaning,  etc 603 

Separation  into  lots 602 

Storage   room 596 

'Proposals.    -(-See  Subsistence,  proposals,  and  contracts.) 

Prosthetic  appliances  ami  apparatus 429,  655-657 

Public  buildings.     (See  Custodians.) 

R. 

Radiographs 506 

Ration  report 152 

Rations 660 

Receipts,  memorandum 585-587 

Reconstruction  officer.  (See  Hospital  organization  and  administration.) 
Reconstruction  Service.  (Sec  Hospital  organization  and  administration.) 
Records : 

Alcohol  and  Narcotic.     (See  Alcohol  and  narcotics.) 


140 

Records— Continued.  Paragraph. 

Clinical — 

Autopsy  findings  to  be  recorded 206 

Charts  to  accompany  patient  appearing  before  board 187 

Compensation  commission 462 

Completion  of,  at  death 189 

At  time  of  transfer ^ 188 

Diets  to  be  noted  on 186 

History  of  previous  admission.-^ 111 

Not  to  be  furnished,  except 114 

Not  to  be  removed  from  ward 190 

Results  of  specimen  examinations  to  be  inserted 204 

Time  of  first  examination  to  be  noted  on 182 

To  be  prepared  under  direction  of  head  nurse 234 

To  show  complete  record 184 

Ward  surgeons  responsible  for  preparation 181 

Dental 246-248 

District  supervisors 46 

Reconstruction 255,  256 

Recreation  for  patients 282 

Red  Cross 250 

Register,  of  in-patients.     (See  also  Appendix) 566^-570 

Registrar,  in  type  A  hospitals.     (See  Hospital  organization  and  Admin- 
istration. ) 
Regulations : 

Corrections  in,  authorized 26 

Enforcement    of 25,  27 

Infraction  of 341 

Officers  to  note  changes  in 27 

Rules  governing  transportation  of  deceased 319 

Rejection  of  proposals 668 

Relatives  to  be  informed  of  admission  of  patient  to  hospital 270 

To  be  informed  of  patient's  death 75, 193 

Relief : 

Dental,  by  commissioned  dental  officers 575 

Fourth-class  stations ^ 557-561,  573 

Authorization  for 557 

Civilian  employees,  not  entitled  at 561 

Fees 558 

Foreign  seamen,  not  entitled  at 561 

Separate  compensation  or  allowance  not  allowed,  unless 559 

Unreasonable  charges  at 560 

In-patients — 

Admission  cards 565 

Admissions,  discharges,  reports,  transfers 566-574 

Admitted  for  examination  and  observation  only 562 

Authorized  in  grave  cases 562 

Contract   hospitals 562-565 

Record  card,  former,  transfer  of '. 571 

Register  of 566-574 

Treatment  of  applicant  not  in  condition  to  be  transferred 574 

Out-patients — 

Home  treatment  of  seamen i _ 547 

Records 553 


141 

Relief — Continued. 

Out-patients— Continued.  Paragraph. 

Register 548-55(5 

Reports 548-550,  552 

Transfers 551 

Relief  Stations,  classes  of,  defined 28-31 

Inspections.     (See  Inspections.) 

Repairs 639,  643-646,709' 

To   property 639 

Reports 48-5S 

Annual 52 

Compensation  Commission.     (See  Employees  Compensation  Commis- 
sion. ) 

Custodian 705,709- 

Efficiency,   nurses 218,  226. 

Personnel 161 

In-patient 566,567 

Monthly 51 

Officers  in  charge  of  units 57 

On  duty  at  first-class  stations , 3 

Out-patient 548-550,  555 

Patients 46-52 

Ration,    monthly 152 

Reconstruction   officer * '256 

Special.     (See  War  Risk  Insurance.) 

Supplementary 435, 436 

Unserviceable    property 600, 607,  608 

Ward 195 

War  Risk  Insurance 22,  23,  474-476,  552 

Weekly  Progress 50- 

Requisitions 130,  627-638 

Special 635-638. 

Restraint  of  insane.     (See  Neuro-psychiatric  patients.) 

Roentgenologist 208 

S. 

Safe,  combination  of 14 

Sale    of    property.   (See    Property.) 

Scarlet  fever,  isolation  of 170, 171 

Seamen : 

Affirmation  of  applicant  to  be  accepted _ 374 

Application  after  60  days'  absence ; 378 

Canal  boat  employees,  not  entitled 361 

.      Certificate  of  discharge,  not  evidence  of  title  to  relief 387 

Certificate -of  owner  or  agent  accepted 367 

Certificate  to  be  furnished  by  master,  on  demand 368 

Closure    of   navigation 371,372. 

Contagious  diseases 383  - 

Disability  while  actually  employed  on  documented  vessel 386 

Doubtful  cases 376,  377 

Vessels 362 

Evidence  to  be  furnished,  by  applicant  for  relief 365 

Expenditures  during  voyage 382 


142 

Seamen— Continued.  Paragraph. 

False  certificate  of  service 370 

Hospital  treatment  not  considered  absence,  to  debar 373 

Indefinite  residence  in  hospital  not  intended 388 

Less  than  sixty  days  service 375 

Masters'  certificates 306 

Merchant  vessels  returned  by  consular  officers . 364 

Pending  cases 380 

Reimbursement  for  expense  incurred  during  disability 384 

Rejection  of  claim  for  relief 369 

Second  certificate  of  service 381 

Signature  required,  from  applicant 379 

"Sixty  days  continuous  service" 366 

Street  brawls,  not  entitled 385 

Temporary  care,  authority  for,  at  minor  stations 389 

Transfers,  authority  for 389 

Valuables  of.     (See  Patients,  deceased.) 

Wrecked  seamen  entitled,  without  reference 363 

Seamen,  foreign 514-517 

Merchant,  officers  not  required  to  attend,  except 564 

Segregation  of  personnel  in  isolation  wards '. 168 

Venereal  diseases 180 

"  Shell  shock  " — term  not  to  be  used „.  272 

Shipments,  on  Government  bill  of  lading- 640 

Sick   call 64 

Specialists.     (See  Officers.) 

Special  cases,  for  study 512 

Special  instructors ._,_, _. i_^i 257 

Special  requisitions  and  purchases : 

Articles  not  on  contract 637 

Emergency  purchases — 

Authority  to  alwajs  be  requested 648 

Bills  incurred  without  special  authority 643 

Citation  of  paragraph  on  all  exigency  vouchers 645 

Exigency,  definitions  of . 646,  647 

Inspection  of  supplies 651 

Medical  officer  in  charge  to  advertise 642 

Methods  to  be  used  in  purchasing  on  authority  of  paragraph  643 644 

Officer  in  temporary  charge  may  order  emergency  purchases^ 649 

Purchases  to  be  made  by  junior  officers  only  when  unavoidable 650 

Furniture,  rugs,  etc . 636 

Instructions  for  preparation  and  forwarding 635 

Invoices 641 

Proposals,  competitive,  failure  to  secure 637 

Repairs  to  property ,_. 639 

Shipment  to  be  made  on  Government  bill  of  lading 640 

Special,  to  be  filled  out  in  respect  to  each  item  listed 638 

State  Supervisors.     (See  District  supervisors.) 

Stationery  and  blank  forms 633,  634 

Status  of  dietitians 157 

Sterilization  of  dishes 168, 180 

Food  containers 168, 180 

Storage  room  for  unserviceable  property 596 


143 

Subsistence,  proposals,  and  contracts:  Paragraph. 

Advertising 672 

Description  of 673 

Approval  of  amounts  over  $100 683 

Under  $100 683 

Bonds  and  sureties 681 

Circular  letters  and  posters,  to  he  similar  in  language 674 

Contracts,  to  be  made  for  the  fiscal  year,  or  some  part  thereof 07!) 

To  be  signed  in  firm  name 680 

Effort  to  be  made  to  have  responsible  dealers  submit  proposals 678 

Officers  may  purchase  ordinary  subsistence  supplies  at  contract  rate 682 

Open  market  purchases 671 

Proposals,  extension  of  items 667 

For  more  than  three  months 669 

Opening   of 665 

Quarterly,  when  practicable 658 

Rejection  of 668 

Recommendation  of  medical  officer  to  be  accepted  in  case  there  is 

delay 670 

Schedules,  grouping  of 663 

Preparation 661 

Separation 663 

To  be  prepared  for  each  class  of  articles 662 

Solicitation  from  three  dealers 677 

Subsistence,  annual  estimates <:r>!) 

Supplies  not  to  exceed  contract  value  of 660 

Sufficient  time  to  be  given  dealers 675 

Supplies,  inferior,  to  be  rejected 685 

Inspection    of 684 

Samples  of,  to  be  submitted 665 

Trade  names,  use  of 664 

Triplicate  signature  and  delivery 67(J 

Subvouchers,  preparation  of 701 

Sunday,  observation  of 18 

Supplies,  food 145-150 

Supply  tables 652-654 

Sureties.     (See  Bonds  and  sureties.) 

Surgeons,  neuro-psychiatric 28O-282 

Ward : ., 181-202 

Surgical  Service 173-177 

Supplies.     (See  Medical  and  surgical  supplies). 

Surveys  of  property 595 

T. 

Teeth,  Compensation  Commission  patients 428 

Telegrams 697 

Telephone  vouchers 698,  609 

Testimonials  of  character 12 

Therapy,  occupational 263-265 

Trade  names,  use  of 664 

Training,  vocational ;  541-545 


144 

Transfers,  of  patients :  Paragraph. 

Compensation  Commission T 440 

In-patients —    ' 

Authority  for 191 

Between  wards 188 

Card  to  be  mailed  to  receiving  officer 508 

Clinical  records  to  be  completed 189 

Emergency 192 

Transportation 325-334 

Insane.       (See  Neuro-psychiatric  patients.) 

Out-patients— _ 551 

War-risk  insurance.     (See  War-risk  insurance.) 
Transfers,  of  property : 

Between  accountable  officers _: 622-626 

Responsibility  for 588, 589 

Unauthorized 590,  591 

Transportation  of  patients.     (See  Patients.) 

Transportation  requests 326-328,  528 

Travel  expense 329-331 

Trespass  on  property 706 

Tuberculosis  wards 166 

U. 

Units,  hospitalization 54-58 

Unserviceable  property.     (See  Property.) 

Urology 173,179 

V. 

Valuables.     (See  Patients.) 

Vehicles,  responsibility  for 132 

Venereal  diseases 180,  465,  466 

Verification  of  drug  record 228 

Visitors : 

Admitted  through  admitting  office 98 

Junior  officers  to  obtain  consent  for 103 

Obnoxious,  reporting  of 300 

Patients  to  be  properly  clothed  for — 299 

Persons  referred  to  medical  officer  in  charge 102 

With  communicable  diseases  denied  admittance 101 

Prohibited  from  visiting  contagious  disease  wards,  except 99 

Undesirables -—  101 

Visiting  days 99 

Women  excluded  from  venereal  disease  wards 100 

Vocational  training —  541-545 

Vouchers : 

Authority  to  be  obtained  for  additional  expenditures—.                 700 

Authorized  expenditures  — 688 

Bills  for  medicines  to  state  name  and  class  of  patients .  696 

Current  prices  to  be  paid  for  medicines .  695 

Memorandum  list  to  accompany 692 

Preparation,  in  accordance  with  instructions 

Of  subvouchers 701 

Prompt  forwarding  of  bills  necessary-, 690 


145 

Vouchers— Continued.  Paragraph. 

Proper  blanks  to  be  used 689 

Restricted  to  items  on  approved  proposals 693 

Telegrams,  official,  to  be  sent  "  collect  " 697 

Not  official,  to  be  paid  by  sender 697 

Telephone  toll  service 698,  699 

To  be  considered  as  transcripts  of  records 694 

Ways  of  paying  telegraph  bills 697 

W. 
Wards : 

Isolation 168-172 

Neuro-psychiatric 167 

Tuberculosis 166 

Ward  employees,  duties 209 

Reports , 195 

Surgeons.    (See  Officers.) 
War  Risk  Insurance.     (See  also  Patients.) 

Correspondence  508-511 

Dental  treatment — 

Assignment  of  officers 477-480 

Bridge  work,  crowns,  and  fillings 495-501 

Classes  of  patients 489 

Costs,  authorizations  for 485 

Dental  examiners  on  fee  basis 481-484 

Dentures - 502-505 

Extraction  of  teeth 493,  494 

Extraordinary  conditions 507 

Forms,  disposition  of,  when  completed 487 

To  be  furnished 483 

Instruction  in  care  of  the  teeth 491 

Letter  of  authority 486 

Precious  metals  not  to  be  used 490 

Prophylactic  treatment 492 

Radiographs 506 

Right  to  treatment  to  be  investigated 488 

District  Supervisors.     (See  District  supervisors.) 

Examinations — 

Discussions  with  patients  prohibited 472 

Hospital  treatment  not  solicited 470 

On  presentation  of  discharge 471 

To  be  complete 469 

Written  reports  necessary 474 

To  be  comprehensive 475 

Patients.     (See  Patients.) 

Prescriptions 468 

Reports 48-52 

Special 22 

Transfers 330,  470,  473 

Venereal  diseases ^ 465,  466 

X-ray —         45 

Waste,  disposal  of . 130 

185279°— 20—— 10 


146 

Paragraph . 

Water,  economy  In  use  of 71H 

Weekly  inspections 356-35JJ 

Written  orders,  from  ward  surgeon 224 

X. 

X-ray  service: 

Compensation  Commission 447-451 

Laboratory  chief  in  charge 203 

Section  under  immediate  supervision  of  roentgenologist 208 


THIS  BOOK  IS  DUE  ON  THE  LAST  DATE 
STAMPED  BELOW 


AN  INITIAL  FINE  OF  25  CENTS 


W1L 


RN 


THIS  BOOK  ON  THE  DATE  DUE.  THE  PENALTY 
WILL  INCREASE  TO  SO  CENTS  ON  THE  FOURTH 
DAY  AND  TO  $1.OO  ON  THE  SEVENTH  DAY 
OVERDUE. 


Mil 

1  iLCSIMiFif 

ISfLA-J 

f 

OCT23  1964  ^fO 

REC.  PUBL  MAR  09 

92 

i^ii^i: 

\-M-V* 

ONfc  MONTH  LOAN 

ir\r\    A  5P   <VAA4 

APR  0  3  2001 

SUBJECTTO  RECALL 

DJT'DPIIRI      MAY  ?  1  '01 

LD  21-100m-12,'43  (8796s) 

